Association between Treatment Complexity and Procedural Fluoroscopic Radiation Exposure In Transarterial Radioembolization Using Yttrium-90 Microspheres
Abstract
Purpose
TheraSphere Global Dosimetry Steering Committee (DSC) defines five clinical scenarios for the treatment of hepatocellular carcinoma (HCC) using Yttrium-90 (Y-90) glass microsphere–based transarterial radioembolization (TARE), accounting for disease extent, tumor biology, and treatment intent. Prescribed Y-90 activity and tumor-absorbed dose differ substantially between curative-intent and palliative-intent scenarios and may be associated with varying levels of fluoroscopic X-ray intraprocedural monitoring. In palliative TARE, multifocal unilobar or bilobar disease, and with or without macrovascular invasion/portal vein thrombosis, may further increase procedural complexity. In this study, TARE treatment complexity was defined based on objective clinical factors expected to impact angiographic planning, catheter manipulation, and treatment delivery time. We quantitatively investigate relationship between treatment complexity and procedural fluoroscopic radiation exposure by integrating treatment planning data with radiation dose structured reports (RDSR).
Methods
A retrospective analysis (aiming for 500 procedures) at two NCI-designated comprehensive cancer centers over a five-year period is in progress. Treatment scenario complexity was determined from written directives and prescriptions in the health information system. Complexity was categorized using classification into DSC-defined clinical scenarios reflecting treatment intent and disease extent, and the number of Y-90 vials administered as a surrogate for procedural extent and technical demand. Patient size metrics, radiation exposure quantities, and imaging technique parameters from image guidance were extracted from DICOM RDSR files. Spearman’s rank correlation was used to assess associations between treatment complexity and radiation exposure.
Results
Preliminary findings showed bilobar palliative treatment scenarios were associated with higher fluoroscopic radiation exposure than unilobar ones. Procedures requiring the administration of additional Y-90 vials were associated with increased Kerma–area product and cumulative air Kerma, with Spearman correlation coefficients of 0.79 and 0.66, respectively.
Conclusion
Radiation exposure from fluoroscopic image guidance is positively correlated with treatment complexity, highlighting opportunities to benchmark and optimize radiation dose in this complex fluoroscopically-guided interventional procedure.