Identifying predictors of patient radiation dose during uterine artery embolisation

Abstract

Introduction: Uterine artery embolisation (UAE) is regarded as a safe and effective treatment for symptomatic uterine fibroids and/or adenomyosis. Dose reduction during UAE is critical for this reproductive-age patient population to minimise the risks of radiation-induced effects. The aim of this study was to identify the predictors of radiation dose which can be controlled and optimised for patients during UAE. Methods: A total of 150 patients between June 2018 and August 2019 were included in this study. Demographic and clinical information such as age, body mass index (BMI), total number of fibroids, total fibroid volume, total uterus volume and dosimetric measurements on Dose Area Product (DAP), Air Kerma (AK) and fluoroscopy time were recorded. Total digital subtraction angiography (DSA), total conventional roadmap (CRM), total last-image hold (LIH) and total fluoroscopy were calculated from the dose report. Multiple linear regression analysis was used to identify the independent predictor variables of total dose (DAP) using a regression model. Results: Total DSA, total CRM and total LIH were identified as the determinants of dose for UAE (P < 0.05) and together accounted for 95.2% of the variance. Conclusions: This study identified the key imaging predictors of dose for UAE. Total DSA, total CRM and total LIH were shown to have a greater impact on the outcome DAP compared to other demographic or dosimetric measurements. Optimisation of these predictors during future UAE procedures can facilitate radiation dose reduction to the pelvis and reproductive organs.

Predictors of radiation dose for uterine artery embolisation are angiography system-dependent

“…A Pearson's correlation matrix was also undertaken to show any significant bivariate correlations between the independent variables included in the regression analysis. An MLR with stepwise elimination (25) was performed using the following predictor variables: BMI, number of fibroids, total fibroid volume, total uterus volume, Ka, r, fluoroscopy time, total DSA dose, total CRM dose, and total fluoroscopy dose. Scatter plots of the predictor variables and KAP were visually checked to confirm the assumption of a linear association between the predictor variables and KAP.…”

“…Under these specific conditions, it was found that total DSA (digital subtraction angiography), total CRM (conventional roadmap), and total LIH (last-image hold) dose as a function of the total procedural KAP were the significant radiation dose predictors identified following multivariable linear regression (MLR) analysis. (25) However, the upgraded system no longer records LIH dose or saved fluoroscopy information in contrast to its previous generation. There is a paucity of literature based on the formulation of regression models for UAE (25)(26)(27) or the application of the identified radiation dose predictors to optimise UAE practice (28) .…”

“…(25) However, the upgraded system no longer records LIH dose or saved fluoroscopy information in contrast to its previous generation. There is a paucity of literature based on the formulation of regression models for UAE (25)(26)(27) or the application of the identified radiation dose predictors to optimise UAE practice (28) . Previous UAE regression models (25)(26)(27) were based on different angiography systems and sets of radiation dose predictor variables and could not be applied to this study.…”

The role of quality improvement in radiography

“…This has formed part of a QA process which has progressed to further studies which aim to fully implement this CQI program for optimising radiation dose during UAE by clinically validating the resultant regression model. 9 The results have demonstrated significant dose reduction, which is critically important for these reproductive‐age UAE patients. This demonstrates that implementing CQI programs to improve quality of care can be beneficial to many medical imaging department procedures.…”

“…A previous study, 9 as part of an overall CQI program by the authors of this editorial, identified dose predictor variables for the interventional radiology procedure uterine artery embolisation (UAE). This has formed part of a QA process which has progressed to further studies which aim to fully implement this CQI program for optimising radiation dose during UAE by clinically validating the resultant regression model.…”