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14.01.2022 | Technical Note

Optimizing the Angiography Protocol to Reduce Radiation Dose in Uterine Artery Embolization: The Impact of Digital Subtraction Angiographies on Radiation Exposure

verfasst von: Alessandro Cina, Lorenzo Steri, Pierluigi Barbieri, Andrea Contegiacomo, Enrico Maria Amodeo, Carmine Di Stasi, Andrea Morasca, Daniela Romualdi, Francesca Ciccarone, Riccardo Manfredi

Erschienen in: CardioVascular and Interventional Radiology | Ausgabe 2/2022

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Abstract

Purpose

The aim was to compare a protocol of uterine artery embolization (UAE) consisting in three digital subtraction angiographies (DSAs)—Group A, with a protocol based on a single DSA—Group B.

Materials and Methods

This is a single-center prospective randomized study enrolling 20 women (mean age 41 years, range 22–55 years) with uterine fibroids treated with UAE, from January 2015 to February 2016. All UAEs were performed by two interventional radiologists using the same angiography machine. Protocol of Group A consisted in three DSA runs (non-selective pelvic view and selective uterine views before and after embolization). Protocol of Group B consisted in 1 DSA run: selective UA angiography before embolization. (Fluoroscopic roadmap was used for UA catheterization; fluoroscopy storage was used as control after embolization.) Each patient was randomized to receive Protocol A in one pelvic side and Protocol B on the other.

Results

All patients received bilateral UAE. Mean fluoroscopy time for UA catheterization was 11.3 ± 3.7 s. (Protocol A) and 9.93 ± 2.99 s. (Protocol B) (p = 0.19). Fluoroscopy dose for catheterization and embolization was not different between both protocols (p = 0.14). Identification of the UA origin score was similar in both protocols (median error = 0, p = 0.79). Mean dose area product (DAP) was 40859 mGy/cm2 (Protocol A) and 28839 mGy/cm2 (Protocol B) (p = 0.003). Mean effective dose (ED) decreased from Protocol A (14.6 mSv) to Protocol B (9.2 mSv; − 37%). Mean absorbed dose (AD) to ovaries and uterus, respectively, decreased of 53% and 55% from Protocol A to Protocol B.

Conclusion

Reducing the number of DSA runs from 3 to 1 during UAE allows at least a 30% reduction on radiation exposure, without compromising technical outcomes.
Literatur
1.
Zurück zum Zitat Freed MM. Spies J B (2010) Uterine artery embolization for fibroids: a review of current outcomes. Semin Reprod Med. 2010;28:235–2412.CrossRef Freed MM. Spies J B (2010) Uterine artery embolization for fibroids: a review of current outcomes. Semin Reprod Med. 2010;28:235–2412.CrossRef
2.
Zurück zum Zitat Poulsen B, Munk T, Ravn T. Long-term follow up after uterine artery embolization for symptomatic uterine leiomyomas. Acta Obstet Gynecol Scand. 2011;90:1281–12833.CrossRef Poulsen B, Munk T, Ravn T. Long-term follow up after uterine artery embolization for symptomatic uterine leiomyomas. Acta Obstet Gynecol Scand. 2011;90:1281–12833.CrossRef
3.
Zurück zum Zitat Spies JB, Bruno J, Czeyda-Pommersheim F, et al. Long-term outcome of uterine artery embolization of leiomyomata. Obstet Gynecol. 2005;106:933–9394.CrossRef Spies JB, Bruno J, Czeyda-Pommersheim F, et al. Long-term outcome of uterine artery embolization of leiomyomata. Obstet Gynecol. 2005;106:933–9394.CrossRef
4.
Zurück zum Zitat Lohle PNM, Voogt MJ, De Vries J, et al. Long-term outcome of uterine artery embolization for symptomatic uterine leiomyomas. J Vasc Interv Radiol. 2008;19:319–3265.CrossRef Lohle PNM, Voogt MJ, De Vries J, et al. Long-term outcome of uterine artery embolization for symptomatic uterine leiomyomas. J Vasc Interv Radiol. 2008;19:319–3265.CrossRef
5.
Zurück zum Zitat Scheurig-Muenkler C, Koesters C, Powerski MJ, et al. Clinical long-term outcome after uterine artery embolization: sustained symptom control and improvement of quality of life. J Vasc Interv Radiol. 2013;24:765–71.CrossRef Scheurig-Muenkler C, Koesters C, Powerski MJ, et al. Clinical long-term outcome after uterine artery embolization: sustained symptom control and improvement of quality of life. J Vasc Interv Radiol. 2013;24:765–71.CrossRef
6.
Zurück zum Zitat Niklic B, Spies JB, Lundsten MJ, Abbara S. Patient RD associated with uterine artery embolization. Radiology. 2000;214:121–5.CrossRef Niklic B, Spies JB, Lundsten MJ, Abbara S. Patient RD associated with uterine artery embolization. Radiology. 2000;214:121–5.CrossRef
7.
Zurück zum Zitat Nikolic B, Spies JB, Campbell L, Walsh SM, Abbara S, Lundsten MJ. Uterine artery embolization: reduced radiation with refined technique. J Vasc Interv Radiol. 2001;12:39–44.CrossRef Nikolic B, Spies JB, Campbell L, Walsh SM, Abbara S, Lundsten MJ. Uterine artery embolization: reduced radiation with refined technique. J Vasc Interv Radiol. 2001;12:39–44.CrossRef
8.
Zurück zum Zitat Dariushnia SR, Nikolic B, Stokes LS, Spies JB. Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol. 2014;11:1737–47.CrossRef Dariushnia SR, Nikolic B, Stokes LS, Spies JB. Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol. 2014;11:1737–47.CrossRef
9.
Zurück zum Zitat Andreo P. Monte carlo techniques in medical radiation physics. Phys Med Biol. 1991;7:861–920.CrossRef Andreo P. Monte carlo techniques in medical radiation physics. Phys Med Biol. 1991;7:861–920.CrossRef
11.
Zurück zum Zitat Van Overhagen H, Reekers JA. CIRSE standard of practice guidelines: uterine artery embolization for symptomatic leiomyomata. Cardiovasc Interv Radiol. 2015;38:536–42.CrossRef Van Overhagen H, Reekers JA. CIRSE standard of practice guidelines: uterine artery embolization for symptomatic leiomyomata. Cardiovasc Interv Radiol. 2015;38:536–42.CrossRef
12.
Zurück zum Zitat European Council Directive 2013/59/Euratom on basic safety standards for protection against the dangers arising from exposure to ionising radiation and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom and 2003/122/Euratom. OJ of the EU. L13; 57: 1–73 (2014). European Council Directive 2013/59/Euratom on basic safety standards for protection against the dangers arising from exposure to ionising radiation and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom and 2003/122/Euratom. OJ of the EU. L13; 57: 1–73 (2014).
13.
Zurück zum Zitat White AM, Banovac F, Spies JB. Patient radiation exposure during uterine fibroid embolization and the dose attributable to aortography. J Vasc Interv Radiol. 2007;18:573–6.CrossRef White AM, Banovac F, Spies JB. Patient radiation exposure during uterine fibroid embolization and the dose attributable to aortography. J Vasc Interv Radiol. 2007;18:573–6.CrossRef
14.
Zurück zum Zitat Andrews RT, Brown PH. Uterine arterial embolization: factors influencing patient radiation exposure. Radiology. 2000;217:713–22.CrossRef Andrews RT, Brown PH. Uterine arterial embolization: factors influencing patient radiation exposure. Radiology. 2000;217:713–22.CrossRef
15.
Zurück zum Zitat Vetter S, Schultz FW, Strecker EP, Zoetelief J. Optimisation strategies and justification: an example in uterine artery 20mbolization for fibroids. Radiat Prot Dosimetry. 2005;117(1–3):50–3.CrossRef Vetter S, Schultz FW, Strecker EP, Zoetelief J. Optimisation strategies and justification: an example in uterine artery 20mbolization for fibroids. Radiat Prot Dosimetry. 2005;117(1–3):50–3.CrossRef
16.
Zurück zum Zitat Miller DL, Kwon D, Bonavia GH. Reference levels for patient RDs in interventional radiology: proposed initial values for U.S practice. Radiology. 2009;253(3):753–64.CrossRef Miller DL, Kwon D, Bonavia GH. Reference levels for patient RDs in interventional radiology: proposed initial values for U.S practice. Radiology. 2009;253(3):753–64.CrossRef
17.
Zurück zum Zitat Scheurig-Muenkler C, Powerski J, Muelle JC. Radiation exposure during uterine artery embolization: effective measures to minimize dose to the patient. Cardiovasc Interv Radiol. 2015;38(3):613–5.CrossRef Scheurig-Muenkler C, Powerski J, Muelle JC. Radiation exposure during uterine artery embolization: effective measures to minimize dose to the patient. Cardiovasc Interv Radiol. 2015;38(3):613–5.CrossRef
18.
Zurück zum Zitat Kohlbrenner R, Kolli KP, Taylor AG, et al. RD reduction during uterine fibroid embolization using an optimized imaging platform. J Vasc Interv Radiol. 2017;28(8):1129–35.CrossRef Kohlbrenner R, Kolli KP, Taylor AG, et al. RD reduction during uterine fibroid embolization using an optimized imaging platform. J Vasc Interv Radiol. 2017;28(8):1129–35.CrossRef
19.
Zurück zum Zitat Sapoval M, Pellerin O, Rehel JL, et al. Uterine artery embolization for leiomyomata: optimization of the RD to the patient using a flat-panel detector angiographic suite. Cardiovasc Interv Radiol. 2010;33:949–54.CrossRef Sapoval M, Pellerin O, Rehel JL, et al. Uterine artery embolization for leiomyomata: optimization of the RD to the patient using a flat-panel detector angiographic suite. Cardiovasc Interv Radiol. 2010;33:949–54.CrossRef
20.
Zurück zum Zitat Schernthaner R, Haroun RR, Nguyen S, et al. Characteristics of a new X-Ray imaging system for interventional procedures: improved image quality and reduced RD. Cardiovasc Interv Radiol. 2018;41:502–8.CrossRef Schernthaner R, Haroun RR, Nguyen S, et al. Characteristics of a new X-Ray imaging system for interventional procedures: improved image quality and reduced RD. Cardiovasc Interv Radiol. 2018;41:502–8.CrossRef
21.
Zurück zum Zitat Thomaere E, Dehairs M, Laenen A, et al. A new imaging technology to reduce the RD during uterine fibroid embolization. Acta Radiologica. 2018;0(0):1–5. Thomaere E, Dehairs M, Laenen A, et al. A new imaging technology to reduce the RD during uterine fibroid embolization. Acta Radiologica. 2018;0(0):1–5.
22.
Zurück zum Zitat Lacayol EA, Khera SS, Spies JB. Impact of patient and procedure-related factors on radiation exposure from uterine artery embolization. Cardiovasc Interv Radiol. 2020. 43(1):120–6.CrossRef Lacayol EA, Khera SS, Spies JB. Impact of patient and procedure-related factors on radiation exposure from uterine artery embolization. Cardiovasc Interv Radiol. 2020. 43(1):120–6.CrossRef
Metadaten
Titel
Optimizing the Angiography Protocol to Reduce Radiation Dose in Uterine Artery Embolization: The Impact of Digital Subtraction Angiographies on Radiation Exposure
verfasst von
Alessandro Cina
Lorenzo Steri
Pierluigi Barbieri
Andrea Contegiacomo
Enrico Maria Amodeo
Carmine Di Stasi
Andrea Morasca
Daniela Romualdi
Francesca Ciccarone
Riccardo Manfredi
Publikationsdatum
14.01.2022
Verlag
Springer US
Erschienen in
CardioVascular and Interventional Radiology / Ausgabe 2/2022
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-021-03032-8

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