Limiting radiation exposure during prostatic arteries embolization: influence of patient characteristics, anatomical conditions, and technical factors.

OBJECTIVE: To assess the influence of patient characteristics, anatomical conditions, and technical factors on radiation exposure during prostatic arteries embolization (PAE) performed for benign prostatic hyperplasia. MATERIALS AND METHODS: Patient characteristics (age, body mass index (BMI)), anatomical conditions (number of prostatic arteries, anastomosis), and technical factors (use of cone beam computed tomography (CBCT), large display monitor (LDM), and magnification) were recorded as well as total air kerma (AK), dose area product (DAP), fluoroscopy time (FT), and number of acquisitions (NAcq). Associations between potential dose-influencing factors and AK using univariate analysis and a multiple linear regression model were assessed. RESULTS: Forty-one consecutive men (68 ± 8 years, min-max: 40-76) were included. LDM and CBCT decreased the use of small field of view with 13.9 and 3.8% respectively, both p < 0.001. The use of a LDM significantly reduced AK (1006.6 ± 471.7 vs. 1412 ± 754.6 mGy, p = 0.02), DAP (119.4 ± 64.4 vs. 167.9 ± 99.2, p = 0.04), FT (40.4 ± 11.5 vs. 53.6 ± 25.5 min, p = 0.01), and NAcq (16.3 ± 6.3 vs. 18.2 ± 7, p = 0.04). In multivariate analysis, AK reduction was associated with lower patient BMI (ß = 0.359, p = 0.002), shorter FT (ß = 0.664, p < 0.001) and CBCT use (ß = - 0.223, p = 0.03), and decreased NAcq (ß = 0.229, p = 0.04). CONCLUSION: LDM and CBCT are important technical dose-related factors to help reduce radiation exposure during PAE, and should be considered in standard practice. KEY POINTS: • The use of large display monitor (LDM) and cone beam computed tomography (CBCT) both decreased the need for magnification during prostatic arteries embolization (PAE). • The use of LDM reduces radiation exposure during PAE. • Total air kerma is associated with patient's body mass index, fluoroscopy time, CBCT, and the number of acquisitions.

Integrative Medicine in Interventional Oncology: A Virtuous Alliance.

This review aimed to identify the potential role of integrative medicine in interventional oncology. The music therapy; stress management techniques; guided imagery, including virtual reality; clinical hypnosis; and digital sedation may all be efficient on anxiety and pain during procedures performed in interventional oncology. Beyond pharmacological sedation, the implementation of integrative medicine to interventional oncology may, therefore, improve the support and care of cancer patients, which may further create a virtuous alliance.

Percutaneous screw fixation of pelvic bone metastases using cone-beam computed tomography navigation.

PURPOSE: The purpose of this study was to evaluate the efficacy of cone-beam computed tomography (CBCT) navigation to achieve percutaneous screw fixation (PSF) of pelvic bone metastases (PBM). MATERIALS AND METHODS: Thirty-five consecutive patients (12 men and 23 women; mean age, 62 ± 11.3 [SD]; range: 39-89 years) treated between 2019 and 2021 were retrospectively included. CBCT navigation software was systematically used. Manual drawing of the entry point (MDEP) was performed when CBCT automatic positioning failed. Influence of metastasis pattern, ablation, body mass index, number of screws, and MDEP on procedure duration (PD) and total Air Kerma (AK) was evaluated. Local pain was assessed before, one and six months after treatment. Variables were compared using Pearson correlation, Student t and Wilcoxon tests. RESULTS: Seventy-five screws were inserted successfully (mean: 2.1 ± 1.1 [SD]; range: 1-5 per patient). CBCT automatic positioning was obtained for 41 screws (55%, 41/75), whereas 34 (45%, 34/75) required MDEP. Mean procedure duration, fluoroscopy time, kerma air product and AK were 73.3 ± 44.8 (SD) min (range: 19-233 min), 13.1 ± 9.5 (SD) min (range: 1.4-38.6 min), 73.8 ± 66.3 (SD) Gy.cm2 (range: 11.6-303.7 Gy.cm2) and 301.7 ± 242.1 (SD) mGy (range: 49.4-1111.5 mGy), respectively. Procedure duration was not significantly longer in patients with mixed or blastic PBM compared to those with lytic PBM or when performing ablation, and no significant correlations were observed with the number of screws inserted (P = 0.19), MDEP (P = 0.37) and BMI (P = 0.44). No adverse events were reported during the follow-up (median: 6 months; IQR: 6-6.5 months). Thirteen patients died during the follow-up related to cancer progression. Local pain decreased from 35 ± 32 (SD) mm (range: 0-10 mm) to 11 ± 20 (SD) mm (range: 0-80 mm) at one month (P = 0.001); and to 22 ± 23 (SD) mm (range: 0-60 mm) at six months (P = 0.001). CONCLUSION: CBCT navigation allows to effectively performing PSF of PBM even in the presence of steep angulations.