Imaging guidance with C-arm CT: Prospective evaluation of its impact on patient radiation exposure during transhepatic arterial chemoembolization

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, Lawrence V. Hofmann

Research output: Contribution to journalArticlepeer-review

37 Scopus citations


Purpose: To prospectively evaluate the impact of C-arm CT on radiation exposure to hepatocellular carcinoma (HCC) patients treated by chemoembolization. Materials and Methods: Patients 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. Results: The 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. Conclusions: Routine 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.

Original languageEnglish (US)
Pages (from-to)1535-1543
Number of pages9
JournalJournal of Vascular and Interventional Radiology
Issue number11
StatePublished - Nov 2011
Externally publishedYes


  • 3D
  • CD
  • DAP
  • DSA
  • HCC
  • MIP
  • PSD
  • cumulative dose
  • digital subtraction angiography
  • dose-area product
  • hepatocellular carcinoma
  • maximum-intensity projection
  • peak skin dose
  • three-dimensional

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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