Radiation exposure during uterine artery embolization: effective measures to minimize dose to the patient

Evaluation of patient radiation exposure during uterine artery embolization (UAE) and literature review to identify techniques minimizing required dose.

A total of 224 of all included 286 (78 %) women underwent UAE according to a standard UAE-protocol (bilateral UAE from unilateral approach using a Rösch inferior mesenteric and a microcatheter, no aortography, no ovarian artery catheterization or embolization) and were analyzed for radiation exposure. Treatment was performed on three different generations of angiography systems: (I) new generation flat-panel detector (N = 108/151); (II) classical image amplifier and pulsed fluoroscopy (N = 79/98); (III) classical image amplifier and continuous fluoroscopy (N = 37/37). Fluoroscopy time (FT) and dose-area product (DAP) were documented. Whenever possible, the following dose-saving measures were applied: optimized source-object, source-image, and object-image distances, pulsed fluoroscopy, angiographic runs in posterior-anterior direction with 0.5 frames per second, no magnification, tight collimation, no additional aortography.

In a standard bilateral UAE, the use of the new generation flat-panel detector in group I led to a significantly lower DAP of 3,156 cGy × cm(2) (544-45,980) compared with 4,000 cGy × cm(2) (1,400-13,000) in group II (P = 0.033). Both doses were significantly lower than those of group III with 8,547 cGy × cm(2) (3,324-35,729; P < 0.001). Other reasons for dose escalation were longer FT due to difficult anatomy or a large leiomyoma load, additional angiographic runs, supplementary ovarian artery embolization, and obesity.

The use of modern angiographic units with flat panel detectors and strict application of methods of radiation reduction lead to a significantly lower radiation exposure. Target DAP for UAE should be kept below 5,000 cGy × cm(2).