Prostate Artery Embolization
Image-guided solutions for PAE
Prostate artery embolization (PAE) is a complex and challenging procedure that requires a cautious approach. Intra-procedural image guidance technology can help IR professionals strike the ideal balance – by providing safe and effective treatment at the lowest possible dose.
Dealing with complex and varied vessel anatomy
The vessel anatomy in the pelvic area varies extremely and includes highly branched, small arteries. This makes catheter navigation a lengthy, laborious process, with a high risk of unintentional non-targeted treatment. Careful assessment of the vasculature as well as thorough planning and monitoring of the procedure is therefore key to performing the intervention effectively and efficiently.
- Access 3D soft-tissue information directly in the angio suite – for planning, guidance and monitoring, reduction of risk of complications, plus confirmation of treatment results
- 200° rotation from HEAD, LEFT and RIGHT side with Artis ceiling systems and ARTIS pheno – for uncompromised 3D soft-tissue image quality in the pelvis and any other body region
Prof. Carnevale: “syngo DynaCT is the most important software for the embolization procedure. It identifies the arteries feeding the prostate, gives me an idea of the percentage of the prostate I am treating, and – even more importantly – helps me avoid non-targeted embolization.”1
syngo Fusion Package
- Choose syngo 3D/3D Fusion or syngo 2D/3D Fusion for easy multimodality integration of pre-procedural CTA, MRA or MRI
- syngo 2D/3D Fusion allows for 3D image guidance during intervention without the need of an intra-procedural 3D scan
- Reduce radiation dose and contrast injections
Balancing procedure safety and low dose in a sensitive body region
The use of 3D image information helps to increase procedure safety, limit the risk of complications in PAE, and achieve better clinical outcomes. On the other hand, it is important to explore all the possible options to actively reduce radiation dose, given that PAE targets an extremely dose-sensitive area of the body.
In line with the CARE strategy, 3D imaging does present opportunities to reduce dose. Dedicated acquisition programs can reduce the number of frames or the dose per frame, thus helping to lower overall radiation dose while maintaining procedure safety.
syngo DynaCT with lower dose
- Perform syngo 3D/3D Fusion based on intra-procedural 3D datasets acquired with up to 72% less dose using the syngo DynaCT Low Dose protocol
- Confirm treatment completion and exclude non-target embolization in dose-sensitive regions with syngo DynaCT Body CARE - a dedicated soft-tissue imaging protocol with less dose and shorter acquisition time
- Slab mode - a cranial/caudal collimation during syngo DynaCT acquisitions - reduces dose by limiting the area examined and improves image quality due to less scattered radiation
Reducing overall radiation dose and contrast material with faster microcatheter navigation
Given the complex vessel anatomy of the pelvic region, it is a challenge to find the arteries that feed the prostate gland, define the optimal catheter position and navigate quickly to the planned treatment position. Long navigation times result in long fluoro times and hence increased radiation exposure. Every Artis system includes a CARE package that actively reduces dose and helps IR specialists to work effectively with low dose settings.
syngo Embolization Guidance
- Simple planning and guidance for catheter-based interventions
- Automatic path computation from a marked proximal position (e.g. the tip of a diagnostic catheter) to the marked distal vessels feeding a lesion
- Compatible with syngo DynaCT as well as CT, PET-CT or MR volumes
- Overlay of planning data onto live fluoroscopy with syngo 3D Roadmap
syngo 3D Roadmap
- Simplify guidewire navigation by overlaying anatomic structures such as 3D vessel trees or planning data with live 2D fluoroscopy or acquisitions
- Improve orientation in all three dimensions when navigating the catheter through complex vessel anatomy
- Reduce catheter navigation times, radiation dose and the amount of contrast material required by using 3D overlay techniques
- Automatic real-time updates for C-arm angulation, SID, zoom and table movement
PAE workflow support
Image guidance software supports the entire PAE workflow – from procedure planning through embolization guidance to confirmation that the treatment is complete.
Overlay targets on live 2D images facilitating feeder reconsideration
Define the target region using lesion segmentation in syngo Embolization Guidance
Fast catheter navigation reduces fluoroscopy time
Define the vessel path using the feeder detection feature in syngo Embolization Guidance
syngo DynaCT Body CARE for confirming or redefining the treatment strategy
Confirm completion and exclude non-targeted embolization
Clinical protocols and case studies
Learn from the PAE pioneers who streamlined their clinical workflow in a way that effective and safe treatment as well as reduction of radiation dose are always highest priority. Get tips and tricks on the use of image guidance, on optimal injection and acquisition protocols, or the integration of pre-interventional imaging during the intervention.
Benign Prostate Hyperplasia treatment supported by syngo DynaCT - Clinical case report by Prof. Sapoval
A 66-year-old male with BPH was treated with bilateral prostatic artery embolization.
See how syngo DynaCT, syngo DynaCT low dose, syngo DynaCT Fusion and syngo Embolization Guidance were used in this case.
Prostate Artery Embolization – A study protocol
This in-depth study protocol features syngo DynaCT Body Care with low dose, as a guide to acquisition and reconstruction.
1The statements by Siemens’ customers described herein are based on results that were achieved in the customer’s unique setting. Since there is no “typical” hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.