Uterine Artery Embolization for Leiomyomata: Optimization of the Radiation Dose to the Patient Using a Flat-Panel Detector Angiographic Suite |
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Authors: | Marc Sapoval Olivier Pellerin Jean-Luc Rehel Nicolas Houdoux Ghizlaine Rahmoune Bernard Aubert Isabelle Fitton |
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Institution: | (1) Department of Cardio Vascular Radiology, Georges Pompidou European Hospital, 20-40 rue Leblanc, 75908 Paris Cedex 15, France;(2) Institute for Radiological Protection and Nuclear Safety (IRSN), BP17, 92262 Fontenay-aux-Roses, France |
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Abstract: | The purpose of this study was to assess the ability of low-dose/low-frame fluoroscopy/angiography with a flat-panel detector
angiographic suite to reduce the dose delivered to patients during uterine fibroid embolization (UFE). A two-step prospective
dosimetric study was conducted, with a flat-panel detector angiography suite (Siemens Axiom Artis) integrating automatic exposure
control (AEC), during 20 consecutive UFEs. Patient dosimetry was performed using calibrated thermoluminescent dosimeters placed
on the lower posterior pelvis skin. The first step (10 patients; group A) consisted in UFE (bilateral embolization, calibrated
microspheres) performed using the following parameters: standard fluoroscopy (15 pulses/s) and angiography (3 frames/s). The
second step (next consecutive 10 patients; group B) used low-dose/low-frame fluoroscopy (7.5 pulses/s for catheterization
and 3 pulses/s for embolization) and angiography (1 frame/s). We also recorded the total dose-area product (DAP) delivered
to the patient and the fluoroscopy time as reported by the manufacturer’s dosimetry report. The mean peak skin dose decreased
from 2.4 ± 1.3 to 0.4 ± 0.3 Gy (P = 0.001) for groups A and B, respectively. The DAP values decreased from 43,113 ± 27,207 μGy m2 for group A to 9,515 ± 4,520 μGy m2
for group B (P = 0.003). The dose to ovaries and uterus decreased from 378 ± 238 mGy (group A) to 83 ± 41 mGy (group B) and from 388 ± 246 mGy
(group A) to 85 ± 39 mGy (group B), respectively. Effective doses decreased from 112 ± 71 mSv (group A) to 24 ± 12 mSv (group
B) (P = 0.003). In conclusion, the use of low-dose/low-frame fluoroscopy/angiography, based on a good understanding of the AEC
system and also on the technique during uterine fibroid embolization, allows a significant decrease in the dose exposure to
the patient. |
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