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 × cm(2) (544-45,980) compared with 4,000 cGy × cm(2) (1,400-13,000) in group II (P = 0.033). Both doses were significantly lower than those of group III with 8,547 cGy × cm(2) (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 × cm(2).