Chemoembolization practice patterns and technical methods among interventional radiologists: results of an online survey

AJR Am J Roentgenol. 2012 Mar;198(3):692-9. doi: 10.2214/AJR.11.7066.


Objective: The objective of our study was to assess patterns of chemoembolization use; identify variations in application, technique, and follow-up; and recognize areas of practice conformity and divergence.

Materials and methods: During August and September 2010, Society of Interventional Radiology (SIR) members with "chemoembolization expertise" were invited to participate in an anonymous online questionnaire.

Results: Two hundred sixty-eight of 1157 invited SIR members (23%) answered the 34-item survey. Respondents were predominantly male (93%) fellowship-trained full-time interventional radiologists (IRs) (87%) in practice for less than 15 years (69%) at community hospitals (61%) in the United States (91%). IRs (53%) most commonly drove therapeutic decision making. Most respondents (61%) performed 1-5 chemoembolizations per month and preferred drug-eluting beads to iodized oil for unifocal (46% vs 39%, respectively) and multifocal (40% vs 30%) hepatocellular carcinoma (HCC), although (90)Y radioembolization was favored when portal vein thrombosis was present (48% vs 28%). IRs showed variability in recognized procedure contraindications. Most respondents agreed on chemotherapeutic regimen but showed variable particle embolization use (17-45%) during oily chemoembolization. The 100- to 300-μm (49%) LC Beads (AngioDynamics) (65%) were the favored drug-eluting beads. Lobar chemoembolization was preferred. Treatment endpoints lacked consensus, but substasis was most desirable (56%). Up to 19% of respondents performed outpatient chemoembolization. Concurrent percutaneous ablation was infrequently used (applied in 0-25% of cases by 61-91% of respondents). Most (up to 74%) IRs preferred CT follow-up with the decision for retreatment based on CT evidence of viable disease (93%).

Conclusion: Variability in chemoembolization practice exists among IRs. Continued investigation of treatment strategies and devices is necessary to better optimize and standardize transcatheter therapies for liver tumors.

MeSH terms

  • Chemoembolization, Therapeutic*
  • Female
  • Humans
  • Internet
  • Male
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Radiography, Interventional*
  • Societies, Medical
  • Surveys and Questionnaires