Hysterosalpingography using a flat panel unit: evaluation and optimization of ovarian radiation dose

Area of Science:

• Radiology
• Medical Physics

Background:

• Hysterosalpingography (HSG) involves radiation exposure, particularly to the ovaries.
• Optimizing radiation dose is essential for patient safety during HSG procedures.

Purpose of the Study:

• To evaluate and optimize radiation dose to the ovaries during hysterosalpingography (HSG).
• To identify imaging parameters that minimize ovarian radiation dose without compromising diagnostic quality.

Main Methods:

• A combined phantom and clinical study approach was employed.
• Phantom studies assessed imaging under various geometrical setups and irradiation conditions.
• Clinical study involved 34 women using different fluoroscopy modes with direct thermoluminescent dosimeter (TLD) measurements for ovarian dose estimation.

Main Results:

• Phantom studies demonstrated significant reductions in air KERMA rate (KR) with beam filtration (4 mm Al and 0.9 mm Cu).
• The 3.75 pulses per second (pps) fluoroscopy mode combined with low-dose beam filtration yielded the least radiation exposure.
• Clinical study showed an average ovarian dose (D) of 0.45 ± 0.04 mGy for 50 seconds of fluoroscopy at 3.75 pps, with no significant difference in diagnostic image quality across modes.

Conclusions:

• Digital spot radiographs can be omitted in modern HSG using flat-panel systems.
• Fluoroscopy at 3.75 pps with 4 mm Al and 0.9 mm Cu beam filtration provides acceptable image quality and an average ovarian dose of 0.45 mGy.
• This optimized method offers lower radiation exposure compared to literature values and is recommended for routine HSG to limit ovarian dose.