Uterine artery embolization: reduced radiation with refined technique

Area of Science:

• Interventional Radiology
• Medical Physics
• Radiation Oncology

Background:

• Uterine artery embolization (UAE) is a common procedure for treating gynecological conditions.
• Radiation exposure is an inherent risk during fluoroscopically guided interventions like UAE.
• Optimizing radiation dose is crucial for patient safety and minimizing potential deterministic effects.

Purpose of the Study:

• To quantify the estimated absorbed ovarian dose (EAOD) and absorbed skin dose (ASD) during UAE.
• To evaluate the effectiveness of pulsed fluoroscopy and refined protocols in reducing radiation dose.
• To compare dose metrics with previous studies using conventional fluoroscopy.

Main Methods:

• Twenty patients undergoing UAE were studied.
• Radiation dose was measured using lithium fluoride dosimeters in the vaginal fornix (for EAOD approximation) and on the skin.
• Low-frequency pulsed fluoroscopy, bilateral catheter techniques, and limited magnified/oblique views were employed to minimize radiation.
• Fluoroscopy time and exposure counts were recorded.

Main Results:

• Mean fluoroscopy time was 10.95 minutes, with a mean of 20.9 angiographic exposures.
• The mean EAOD was 9.5 cGy, and the mean ASD was 47.69 cGy.
• These doses are substantially lower than those reported with non-pulsed fluoroscopy (EAOD 22.34 cGy, ASD 162.32 cGy) and well below skin injury thresholds.

Conclusions:

• Pulsed fluoroscopy, combined with dose reduction techniques, significantly lowers EAOD and ASD during UAE.
• The observed dose reductions (less than 1/2 for EAOD, 1/3 for ASD) are statistically significant.
• Implementing these radiation reduction strategies is recommended for all UAE procedures.