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Radiation Exposure During Uterine Artery Embolization: Effective Measures to Minimize Dose to the Patient

  • Clinical Investigation
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Abstract

Purpose

Evaluation of patient radiation exposure during uterine artery embolization (UAE) and literature review to identify techniques minimizing required dose.

Methods

A total of 224 of all included 286 (78 %) women underwent UAE according to a standard UAE-protocol (bilateral UAE from unilateral approach using a Rösch inferior mesenteric and a microcatheter, no aortography, no ovarian artery catheterization or embolization) and were analyzed for radiation exposure. Treatment was performed on three different generations of angiography systems: (I) new generation flat-panel detector (N = 108/151); (II) classical image amplifier and pulsed fluoroscopy (N = 79/98); (III) classical image amplifier and continuous fluoroscopy (N = 37/37). Fluoroscopy time (FT) and dose-area product (DAP) were documented. Whenever possible, the following dose-saving measures were applied: optimized source-object, source-image, and object-image distances, pulsed fluoroscopy, angiographic runs in posterior-anterior direction with 0.5 frames per second, no magnification, tight collimation, no additional aortography.

Results

In a standard bilateral UAE, the use of the new generation flat-panel detector in group I led to a significantly lower DAP of 3,156 cGy × cm2 (544–45,980) compared with 4,000 cGy × cm2 (1,400–13,000) in group II (P = 0.033). Both doses were significantly lower than those of group III with 8,547 cGy × cm2 (3,324–35,729; P < 0.001). Other reasons for dose escalation were longer FT due to difficult anatomy or a large leiomyoma load, additional angiographic runs, supplementary ovarian artery embolization, and obesity.

Conclusions

The use of modern angiographic units with flat panel detectors and strict application of methods of radiation reduction lead to a significantly lower radiation exposure. Target DAP for UAE should be kept below 5,000 cGy × cm2.

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Conflict of interest

The authors certify that there is no actual or potential conflict of interest in relation to this article.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Charité Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Christian Scheurig-Muenkler & Johann-Christoph Mueller

  2. Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany

    Maciej J. Powerski

  3. Department of Radiology, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany

    Thomas J. Kroencke

Authors
  1. Christian Scheurig-Muenkler
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  2. Maciej J. Powerski
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  3. Johann-Christoph Mueller
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  4. Thomas J. Kroencke
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Correspondence to Christian Scheurig-Muenkler.

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Scheurig-Muenkler, C., Powerski, M.J., Mueller, JC. et al. Radiation Exposure During Uterine Artery Embolization: Effective Measures to Minimize Dose to the Patient. Cardiovasc Intervent Radiol 38, 613–622 (2015). https://doi.org/10.1007/s00270-014-0962-6

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  • DOI: https://doi.org/10.1007/s00270-014-0962-6

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