The factors contributing to the total radiation exposure of patients during uterine artery embolisation

Abstract

Uterine artery embolisation (UAE) is an interventional angiography procedure for the treatment of symptomatic fibroids and/or adenomyosis in women. UAE is a less invasive and non‐surgical alternative to hysterectomy or myomectomy. However, ionising radiation is used for both fluoroscopic and angiographic image guidance to visualise and access the uterine arteries for embolisation and treatment of these benign conditions. Identifying the contributors and implementing dose reduction techniques are particularly important as UAE patients are usually of child‐bearing age. The purpose of this review was to examine the progression of literature on radiation exposure measurements and identifying the factors contributing to the total radiation exposure of female patients undergoing UAE. A Medline, ProQuest Central, ScienceDirect and Scopus database search from 2000 to 2018 was performed and forty articles were deemed acceptable for review following the inclusion and exclusion criteria set. UAE is a viable alternative to hysterectomy and myomectomy, as the reviewed literature demonstrated that the reported radiation exposure doses appear to be below the threshold for any deterministic radiation risks. The total radiation exposure of UAE patients is affected independently by multiple patient, operator expertise and technique, angiographic imaging and x‐ray unit variables. Uterus preservation can be attained post‐UAE with dose reduction and optimisation, however, a longitudinal study on UAE patients and their risk of radiation‐induced deterministic and/or stochastic effects is recommended.

Pressure-Induced Fibroid Ischemia: First-In-Human Experience with a Novel Device for Laparoscopic Treatment of Symptomatic Uterine Fibroids

“…Another notable difference between PIFI and UAE is that by applying pressure to the treated fibroid, the PIFI system treatment outcome is not affected by variations in the fibroid vascularization known to predict UAE failure [ 64 ]. On the safety side, use of the PIFI system does not require ionizing radiation that is administered during UAE and involves exposure of the patient’s uterus and ovaries to a direct X‐ray beam [ 81 ]. This is particularly important to patients of childbearing age, as is the inapplicability of another UAE complication, premature menopause induced by non-target embolization of the ovarian parenchyma [ 82 ], to the PIFI system evaluated in this study.…”

Unilateral Uterine Artery Embolization as a Treatment for Patients with Symptomatic Fibroids—Experience in a Case Series

“…Apart from this, a significantly lower dose of radiation was needed if only one uterine artery was embolized. This is a potential advantage of this therapeutic approach, especially considering the fact that UAE patients are usually of child-bearing age, and all measures should be taken to minimize the effects of X-rays on their reproductive organs [13,14]. In terms of clinical results and patient satisfaction, no differences were observed when comparing unilateral and bilateral embolization.…”

Uterine artery embolization

“…Середня доза іонізувального опромінення становить 0,04-0,22 Гр, середня ефективна доза -22-34 мЗв. Середній час рентгеноскопії процедури -22 хв [60,61].…”