Reduced Radiation and Contrast Dose Using Image Fusion Guidance During Endovascular Embolization of Pulmonary Arteriovenous Malformations

Purpose To evaluate whether image fusion guidance reduces contrast media consumption and radiation exposure during endovascular embolization of pulmonary arteriovenous malformations (PAVM).Material and methods A retrospective analysis was performed on 38 endovascular embolization procedures conducted for PAVMs at a tertiary care university hospital between 2009 and 2022. Image fusion guidance was employed in 22 procedures, while the remaining 16 procedures served as a control group. Key metrics for comparison included contrast media usage and radiation exposure, the latter measured indirectly by dose-area product (DAP) and fluoroscopy time.Results Significant reductions in both contrast media use and radiation exposure were observed with the implementation of image fusion guidance. The median contrast dose was 0.18 g I/kg in the image fusion group compared to 0.62 g I/kg in the control group (p = 0.001). Similarly, the DAP was 22.4 Gy·cm2 versus 86.6 Gy·cm2 (p = 0.04), and fluoroscopy time was 31.2 min compared to 55.7 min (p = 0.04).Conclusion In this observational study, image fusion guidance was associated with reduced contrast media usage and radiation exposure during endovascular embolization of PAVMs, without compromising procedural outcomes. These findings provide supportive rather than definitive evidence and warrant confirmation in prospective studies.