Foetal Radiation Dose During Prophylactic Occlusion Balloon Placement for Morbidly Adherent Placenta

Abstract

FAD during POBC insertion is low overall. The only change between the two groups was in pulsed fluoroscopy rate which resulted in a significant reduction in FAD. This reinforces the importance of implementation of dose reduction techniques.

Preoperative Prophylactic Balloon-Assisted Occlusion of the Internal Iliac Arteries in the Management of Placenta Increta/Percreta

“…The optimal placement site of the balloon catheter can be a critical factor affecting outcomes and side effect incidence [ 13 ]. In most studies, the anterior division of the internal iliac artery was used as the side of ballooning for vessel occlusion, but positions as proximal as the abdominal aorta and as distal as those within the anterior division of the internal iliac arteries have been employed [ 1 , 2 , 6 , 7 , 8 , 9 , 10 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. We used the proximal part of the internal iliac artery just after the common iliac artery bifurcation; this approach reduces the intervention time, collateral blood flow rate, and fetal radiation exposure degree more than occlusion of the anterior division of the internal iliac artery [ 17 ].…”

Data and methods to estimate fetal dose from fluoroscopically guided prophylactic hypogastric artery balloon occlusion

“…Previous studies have shown that fetal radiation doses during HABO exhibit a large variation from 0.7 to 28.7 mGy. 12,13 Manninen et al 12 employed dosimeters placed in various locations in the vaginal fornix of seven patients undergoing HABO to provide data on fetal dose. However, the dose measured inside the vaginal fornix cannot be considered a good approximation of dose to the fetus at the ninth month of gestation.…”

“…Fetal dose, estimated using the NFD data presented herein (Table I) for the reference field location, and previously published exposure parameters employed in HABO, 12 ranges from 0.7 to 2.6 mGy (mean = 1.4 mGy). Semerano et al 13 have recently published results on fetal dose from HABO procedures using the  Monte Carlo software and a mathematical phantom representing a nonpregnant female. In that study, fetal dose was considered as the dose absorbed by the uterus of a nonpregnant female.…”

“…Literature research has revealed that currently only two articles have been published on this subject. [12][13][14] Manninen et al 12 have estimated fetal radiation dose from HABO by measuring in vivo the absorbed dose to the vaginal fornix. However, radiation doses measured at close but out of the fetal tissue may differ considerably from the actual fetal dose.…”

“…More recently, Semerano et al have assessed fetal dose from HABO procedures using a nonpregnant female mathematical phantom model. 13 However, dose measured on the uterus of a nonpregnant patient may provide only a rough approximation of fetal dose at the third trimester of gestation.…”