• Nishita Kothary, Mohamed H K Abdelmaksoud, Alessia Tognolini, Rebecca Fahrig, Jarrett Rosenberg, David M Hovsepian, Arundhuti Ganguly, John D Louie, William T Kuo, Gloria L Hwang, Alison Holzer, Daniel Y Sze, and Lawrence V Hofmann.
• Division of Interventional Radiology, H-3652, Stanford University Medical Center, Stanford, CA 94305-5642, USA. kothary@stanford.edu
• J Vasc Interv Radiol. 2011 Nov 1; 22 (11): 1535-43.

PurposeTo prospectively evaluate the impact of C-arm CT on radiation exposure to hepatocellular carcinoma (HCC) patients treated by chemoembolization.Materials And MethodsPatients with HCC (N = 87) underwent digital subtraction angiography (DSA; control group) or combined C-arm CT/DSA (test group) for chemoembolization. Dose-area product (DAP) and cumulative dose (CD) were measured for guidance and treatment verification. Contrast agent volume and C-arm CT utility were also measured.ResultsThe marginal DAP increase in the test group was offset by a substantial (50%) decrease in CD from DSA. Use of C-arm CT allowed reduction of DAP and CD from DSA imaging (P = .007 and P = .017). Experienced operators were more efficient in substituting C-arm CT for DSA, resulting in a negligible increase (7.5%) in total DAP for guidance, compared with an increase of 34% for all operators (P = .03). For treatment verification, DAP from C-arm CT exceeded that from DSA, approaching that of conventional CT. The test group used less contrast medium (P = .001), and C-arm CT provided critical or supplemental information in 20% and 17% of patients, respectively.ConclusionsRoutine use of C-arm CT can increase stochastic risk (DAP) but decrease deterministic risk (CD) from DSA. However, the increase in DAP is operator-dependent, thus, with experience, it can be reduced to under 10%. C-arm CT provides information not provided by DSA in 33% of patients, while decreasing the use of iodinated contrast medium. As with all radiation-emitting modalities, C-arm CT should be used judiciously.Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

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