Abstract No. 475 - Impact of a novel balloon occlusion technique on fluoroscopy time and radiation dose during Y90 radioembolization

Abstract

No. 475 Impact of a novel balloon occlusion technique on fluoroscopy time and radiation dose during Y90 radioembolization Black, A.K. Jones, A. Mahvash, B.C. Odisio, R. Avritscher, J. Ensor, Jr., R. Murthy, J.R. Steele, Jr.; Interventional Radiology, UT MD Anderson, Houston, TX; Imaging Physics, UT MD Anderson, Houston, TX; Biostatistics, UT MD Anderson, Houston, TX Purpose: To assess the impact of a novel balloon occlusion technique on time and dose metrics during Y90 radioembolization (Y90 RE) Materials and Methods: Prior to July 2011, Y90 RE was performed following standard coil embolization of all hepatoenteric collaterals. After July 2011, a technique was introduced whereby a temporary occlusion balloon was inflated in the common hepatic artery, resulting in hepatopedal flow in hepatoenteric collaterals, eliminating the need for coil embolization. A retrospective review of sequential patients who underwent Y90 RE before and after the introduction of the balloon occlusion technique was performed. Data were gathered from the radiology information system and the electronic medical record. Only patients with Michel’s classification type 1 anatomy were included. Results: 22 coil embolization patients and 21 balloon occlusion patients were included. The logarithms of the data were analyzed using two-tailed t-tests as the data followed log-normal distributions. The geometric means of fluoroscopy time (FT, 30.5 vs 13.9 min, -54%), dose area product (DAP, 735.0 vs 597.3 Gy-cm2, -19%), reference air kerma (Kar, 3,006 vs 2,397 mGy, -20%), and number of DSA runs (#DSA, 19.5 vs 18.0, -7.7%) all decreased in the balloon occlusion group versus the coil embolization group, however only the decrease in FT was statistically significant (FT: po0.0001; DAP: p1⁄40.261; Ka,r: p1⁄40.202; #DSA: p1⁄40.479). The lack of significance of the decreases in DAP and Kar was attributed to the much lower Kar rate in fluoroscopy compared to DSA (50-80x), and the fact that a similar number of angiograms are acquired regardless of the technique used. Conclusion: Use of a temporary occlusion balloon catheter versus coil embolization significantly decreased fluoroscopy time during Y90 RE. A larger sample size is necessary to determine if this technique results in reductions in DAP and Kar that are significant.