II. Uterine fibroid embolization: Technical aspects

Uterine Fibroids: Contrast-enhanced MR Angiography to Predict Ovarian Artery Supply—Initial Experience

“…Some authors perform aortography before and after UAE, which adds about 4.1 mSV to the effective dose for each patient (11,13,20). Others take a "wait-and-see" approach and reserve aortography for those cases in which UAE is a clinical failure (21). However, acquisition of a flush aortogram only in cases of clinical failure, which becomes obvious 3-4 months after UAE at the earliest, still leaves at least 5%-8% of all patients with the prospect of a second invasive angiography study to verify and treat ovarian artery supply of fibroids.…”

Collateral Uterine Arterial Supply in the Setting of Various Uterine Pathologies

“…8 Perioperative imaging is an important factor in identifying collaterals in different uterine pathologies. Preoperative cross-sectional imaging, such as MR angiography (MRA), 13 can facilitate procedure planning by allowing evaluation of vascular anatomy and potential collateral arterial supply to the uterus. While preoperative imaging should be utilized to improve procedural planning, preoperative imaging is not possible in all types of uterine pathology, especially in urgent situations, such as intractable uterine hemorrhage.…”

The factors contributing to the total radiation exposure of patients during uterine artery embolisation

“…UAE predisposes patients to ionising radiation, particularly the patients’ uterus and ovaries which are in direct x‐ray beam for prolonged periods of time. This counteracts the aim of the procedure to preserve these radiosensitive organs and potentially maintain fertility . It is difficult to determine the likelihood that the dose associated with UAE causes an increased risk related to the patient’s fertility.…”

“…Multiple variables that are beyond the control of the radiographer and radiologist were identified that contribute to radiation exposure, including; the conversion efficiency of the imaging chain (fluoroscopic equipment), larger body habitus patients and large fibroid mass sizes (incident radiation is proportional to tissue volume and density) . The following radiographer and radiologist controllable variables reduce the overall radiation exposure to the patient; minimising object‐image distance, use of low–dose and/or pulsed fluoroscopy and limiting the use of oblique projections, magnification and digitally subtracted acquisition runs …”