Radiogenic risks from hysterosalpingography

Abstract

The aim of this study was to determine ovarian dose, effective dose and associated radiogenic risks from hysterosalpingography (HSG), and to provide data for the estimation of radiogenic risks related to HSG studies performed in any laboratory. The fluoroscopy time, number of radiographs taken and entrance surface dose were measured in a series of 78 consecutive patients undergoing HSG as part of their infertility work-up. Organ-dose values per radiograph and per minute of fluoroscopy were separately determined using an anthropomorphic phantom and thermoluminescence dosimetry. The radiogenic risk for deleterious effects on a possible future embryo and the radiogenic risk for cancer induction on the patient undergoing HSG were estimated. The average HSG procedure in our laboratory involves a mean fluoroscopic time of 0.3 min and a mean number of radiographs of 3.2. The dose to female gonads from an average HSG procedure was 2.7 mGy and the patient effective dose was 1.2 mSv. The risk for radiogenic anomalies in a future embryo of the woman undergoing an average HSG procedure and the risk for radiogenic fatal cancer induction in the exposed woman were estimated to be less than 10(-3) of the correspondent nominal risks. Radiation risks from a typical HSG are low, but they may be elevated if fluoroscopic and/or radiographic exposures are prolonged for any reason. Present data allow the estimation of radiogenic risks associated with HSG procedures performed in other laboratories with use of different equipment, screening time and number of radiographs taken.

Cancer incidence risks to patients due to hysterosalpingography

“…[8] Careful analysis of the working procedures and clinical protocols generally used in radiological practise, to avoid unnecessary exposures with no loss in diagnostic information, is required. [9]…”

Hysterosalpingography with use of mobile C-arm fluoroscopy

“…There have been a number of dosimetric studies evaluating gonadal radiation exposure during hysterosalpingograms (3,4,9,10). Each reports slightly different values as technologies have improved and protocols differ by institution with varying fluoroscopy times and number of radiographs obtained.…”

“…Changes in HSG protocols intended to limit the number of exposures, such as elimination of the routine oblique and lateral radiographic projections, have reduced radiation exposure (9). The use of digital fluoroscopy for HSG has been shown to reduce patient radiation exposure compared with analogue fluoroscopy (4).…”

Rate of Detection of Unsuspected Pregnancies After Implementation of Mandatory Point-of-Care Urine Pregnancy Testing Prior to Hysterosalpingography

“…Dose to the female gonads from an average hysterosalpingographic procedure has been found to be low (1.2 mSv) [3], but risks to the embryo due to the mechanical trauma of the contrast material injection are uncertain. Spontaneous abortions after HSG have been reported [4], although whether such abortions were caused by HSG or were coincidental is difficult to determine given the small number of reported cases.…”