Uterine artery embolization: Reduced radiation with refined technique

PURPOSE: To determine the estimated absorbed ovarian dose (EAOD) and absorb ed skin dose (ASD) that occurs during uterine artery embolization (UAE) usi ng pulsed fluoroscopy and a refined procedure protocol. MATERIALS AND METHODS: The absorbed dose was measured in 20 patients who un derwent UAE procedures. Radiation was limited by using low frequency pulsed fluoroscopy, bilateral catheter technique with simultaneous injections for embolization as well as pre-and postembolization exposures and focus on li mitation of magnified and oblique fluoroscopy. Lithium fluoride dosimeters were placed both in the posterior vaginal fornix and on the skin at the bea m entrance site. The vaginal dose was used to approximate the EAOD. Fluoros copy time and exposures were recorded. The mean values for all patients wer e calculated and compared to our previous results obtained with conventiona l fluoroscopy and to threshold doses for the induction of deterministic ski n injury. RESULTS: Mean fluoroscopy time was 10.95 min. (range 6-21.3 min.) and the m ean number of angiographic exposures was 20.9 (range 14-53). The mean EAOD was 9.5 cGy (range 2.21-23.21 cGy) and the mean ASD was 47.69 cGy (range 10 .83-110.14 cGy). This compares to previous results with non-pulsed fluorosc opy of an EAOD of 22.34 cGy (range 4.25-65.08 cGy) and an ASD of 162.32 cGy (range 66.01-303.89 cGy) as well as threshold doses for induction of deter ministic radiation injury to the skin (400-500 cGy). CONCLUSION: When pulsed fluoroscopy is used with emphasis on dose reduction techniques, the EAOD and ASD can be substantially reduced to less than 1/2 (P = .017) and 1/3 (P < .0001) when compared to UAE performed with nonpuls ed fluoroscopy. These radiation reduction tools should therefore be applied whenever possible.