Uterine arterial embolization: Factors influencing patient radiation exposure

PURPOSE: To investigate patient radiation exposures during uterine arterial embolization and the factors responsible for those exposures. MATERIALS AND METHODS: Clinical and procedural factors were evaluated for 42 consecutive procedures performed in 39 patients by one operator. Seven patients were excluded because of early termination (n = 1) or unusual conditions that necessitated extended procedures (n = 6). Fluoroscopic time, number of images acquired, height, and weight were available in the 35 remaining patients, and dose-area product (DAP) was available in 20. Equipment factors were evaluated by using a Lucite phantom in four angiography units from three manufacturers. RESULTS: The mean fluoroscopic time per case decreased from 30.6 to 14.2 minutes between the 1st and 5th quintiles. Mean DAP decreased from 211.4 to 30.6 Gy · cm² with dose reduction techniques; this primarily reflected a decreased number of acquired images. Phantom studies demonstrated many significant dose variations with magnification and equipment position. Low-dose and pulsed fluoroscopic modes reduced exposure rates in units so equipped, but roadmapping caused a silent switch to continuous fluoroscopy in two such units, which doubled the exposure rate. CONCLUSION: 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.