Uterine Arterial Embolization: Factors Influencing Patient Radiation Exposure

Andrews, Robert T.; Brown, Paul H.

doi:10.1148/radiology.217.3.r00dc30713

Cited by 65 publications

(39 citation statements)

References 15 publications

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“…Effective measures include optimized source-object, source-image, and object-image distances, the avoidance of magnification and oblique projections, tight collimation to the relevant anatomy, the use of pulsed fluoroscopy with decreased image frequency, and the use of low frame rates or even last-image-hold to document angiographic endpoints [9,13]. Flat panel detectors improve image quality while reducing radiation exposure, and pre-interventional optimization of the tube angle by 3D-reconstructed contrast-enhanced MR angiography helps to avoid conventional survey aortography [11,22,23].…”

Section: Discussionmentioning

confidence: 99%

“…Flat panel detectors improve image quality while reducing radiation exposure, and pre-interventional optimization of the tube angle by 3D-reconstructed contrast-enhanced MR angiography helps to avoid conventional survey aortography [11,22,23]. In particular, angiography units allowing the selection of lower pulse rates during fluoroscopy contribute to a significant reduction in the overall fluoroscopy time and the radiation dose exposure of patients undergoing UFE [9,24]. In the Artis Zeego Q angiography unit (Group 1), radiation dose has been further reduced by copper prefiltration and automatic exposure control.…”

Section: Discussionmentioning

confidence: 99%

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Radiation Exposure During Uterine Fibroid Embolization (UFE): A Confounder-Controlled Comparison Between a State-of-the-Art Angiography Unit and a Conventional Angiography unit

Sommer

Voigt

Oliger

et al. 2017

Fortschr Röntgenstr

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ZUSAMMENFASSUNGZiel Vergleich der Strahlenexposition zwischen einem modernen und einem konventionellen Angiografiesystem bei Patientinnen, die sich einer Uterusmyomembolisation (UME) unterzogen. Ergebnisse Die Einschlusskriterien wurden von 58 (Gruppe 1) bzw. 177 (Gruppe 2) Patientinnen erfüllt. Nach Propensity Score Matching ergaben sich keine signifikanten Unterschiede zwischen Gruppe 1 (n = 46) and Gruppe 2 (n = 92) bezüglich Alter, Body-Mass-Index, Volumen des dominanten Myoms, Uterusvolumen, Fluoroskopiezeit und Embolisatmenge (jeweils p ≥ 0,10). Das Dosisflächenprodukt war in Gruppe 1 signifikant geringer als in Gruppe 2 (1159,0 cGycm 2 vs. 3123,5 cGycm 2 ; p < 0,001), während die Major-Komplikationsrate (0 % in beiden Gruppen) und der Grad der Devaskularisation des dominanten Myoms (100 % in beiden Gruppen) vergleichbar waren (p > 0,99 Material und Methoden ABSTR AC TPurpose To compare radiation exposure of a state-of-the-art and a conventional angiography unit in patients undergoing uterine fibroid embolization (UFE). Materials and MethodsBetween January 2009 and December 2016, 286 patients underwent UFE in our Interdisciplinary Fibroid Center. The inclusion criteria for this retrospective analysis were first-time transarterial embolization for symptomatic fibroids, bilateral embolization, procedures applying a state-of-the-art (Group 1) or a conventional angiography unit (Group 2), and bilateral technical success with an adequate embolization endpoint after the injection of microspheres. Study endpoints included radiation exposure, major complications, morphological success (MRI), and clinical success (questionnaire on quality-of-life). Propensity score matching controlled for confounders.Results The inclusion criteria were met by 58 (Group 1) and 177 (Group 2) patients. After propensity score matching, there was no significant difference between Group 1 (n = 46) and Group 2 (n = 92) regarding age, body-mass index, volume of the dominant fibroid and the uterus, fluoroscopy time, and amount of embolic agent (p ≥ 0.10 each). The dose-area product was significantly lower in Group 1 than in Group 2 (1159.0 cGycm 2 vs. 3123.5 cGycm 2 ; p < 0.001), while major complication rates (both groups 0 %) and dominant fibroid devascularization (both groups 100 %) were equal (p > 0.99). There were no significant differences between both groups regarding shrinkage of the dominant fibroid and the uterus and no relevant differences regarding patient-reported quality-of-life.Conclusion A state-of-the-art angiography unit has the potential to reduce radiation exposure in patients undergoing UFE without increasing the risk of major complications and with comparably high morphological and clinical success.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Radiation Exposure During Uterine Fibroid Embolization (UFE): A Confounder-Controlled Comparison Between a State-of-the-Art Angiography Unit and a Conventional Angiography unit

Sommer

Voigt

Oliger

et al. 2017

Fortschr Röntgenstr

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“…Radiation exposure occurring during UAE is a significant concern because many women who are candidates for the procedure are of childbearing age. With operator experience and limiting fluoroscopy time, the use of magnified and oblique views, non-pulsed fluoroscopy and road-mapping, the absorbed ovarian dose may be minimized (Andrews & Brown 2000;Binkert et al, 2001).…”

Section: Postprocedural Carementioning

confidence: 99%

Is Embolization Equal to Hysterectomy in Treating Uterine Fibroids?

Strinić¹

2012

Hysterectomy

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“…Several methods have been suggested to reduce the dose, including bilateral femoral access and low imaging frame rates (10)(11)(12). Additionally, it has been shown that the interventionist's experience has a strong impact on reducing the number of runs needed to determine the best uterine artery (UA) catheterization angle, and therefore reducing the total radiation dose (13).…”

mentioning

confidence: 99%

“…This initially chosen projection is often suboptimal, and one or even several additional X-ray acquisitions are performed before the UA can be catheterized. DSA acquisitions are a major contributor to the total radiation administered to the patient (13). Therefore, minimizing the number of DSA runs has been associated with a lower patient dose and a reduction of the amount of administered iodinated contrast medium (14).…”

mentioning

confidence: 99%

Three-dimensional rotational angiography is preferable to conventional two-dimensional techniques for uterine artery embolization

Gupta¹,

Zuurmond²,

Grünhagen³

et al. 2013

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to investigate the potential benefits of three-dimensional rotational angiography (3DRA) compared to two-dimensional (2D) roadmapping to visualize the uterine artery (UA) origins during uterine artery embolization (UAE) procedures. MATERIALS AND METHODSSixty-three UAE cases performed under 3DRA guidance were reviewed retrospectively to determine if there was an optimal angiographic projection angle for identifying UA origin. Digital subtraction angiogram (DAS)-like images of the pelvic vessels were generated from the 3DRA scans at six different angles: left anterior oblique (LAO) 25°, 35°, 45°; and right anterior oblique (RAO) 25°, 35°, 45°. Two experienced interventional radiologists assessed if these angles could effectively serve as a roadmap to guide catheterization of the UA. Assessment was validated against original 3DRA scans to determine the percentage of true and false positives. RESULTSNo single projection angle was found that could consistently be utilized for UA catheterization. The projection angles used during 3D roadmapping for both the left and right UA showed two clusters with both a wide spread: RAO 20° to 50° and LAO 20° to 50°. More than 50% of the DSA-like images at RAO and LAO 45° appeared to be adequate for UA catheterization, but validation against the 3DRA revealed 28% of these images were suboptimal and deceptive, due to unappreciated overlapping vessels. CONCLUSIONNo standard projection angles can be recommended with 2D roadmapping to consistently visualize UA origin. The 3DRA can be as a useful tool for UAE to achieve reliable and consistent visibility of the UA origin.

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Uterine Arterial Embolization: Factors Influencing Patient Radiation Exposure

Abstract: With operator experience and careful technique, uterine arterial embolization can be performed at radiation exposures comparable to those used in routine diagnostic studies. However, operators must be familiar with the technical parameters of their angiographic equipment.

Cited by 65 publications

References 15 publications

Radiation Exposure During Uterine Fibroid Embolization (UFE): A Confounder-Controlled Comparison Between a State-of-the-Art Angiography Unit and a Conventional Angiography unit

Radiation Exposure During Uterine Fibroid Embolization (UFE): A Confounder-Controlled Comparison Between a State-of-the-Art Angiography Unit and a Conventional Angiography unit

Is Embolization Equal to Hysterectomy in Treating Uterine Fibroids?

Three-dimensional rotational angiography is preferable to conventional two-dimensional techniques for uterine artery embolization

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