Uterine Artery Embolisation: Continuous Quality Improvement Reduces Radiation Dose While Maintaining Image Quality

Abstract

The purpose of this study was to introduce a continuous quality improvement (CQI) program for radiation dose optimisation during uterine artery embolisation (UAE) and assess its impact on dose reduction and image quality. The CQI program investigated the effects of optimising radiation dose parameters on the kerma-area product (KAP) and image quality when comparing a ‘CQI intervention’ group (n = 50) and ‘Control’ group (n = 50). Visual grading characteristics (VGC) analysis was used to assess image quality, using the ‘Control’ group as a reference. A significant reduction in KAP by 17% (P = 0.041, d = 0.2) and reference air kerma (Ka, r) by 20% (P = 0.027, d = 0.2) was shown between the two groups. The VGC analysis resulted in an area under the VGC curve (AUCVGC) of 0.54, indicating no significant difference in image quality between the two groups (P = 0.670). The implementation of the CQI program and optimisation of radiation dose parameters improved the UAE radiation dose practices at our centre. The dose reduction demonstrated no detrimental effects on image quality.

Comparison of image quality assessments between interventional radiographers and interventional radiologists using digital subtraction angiography

“…This monitor was autocalibrated to the "general radiology" setting by the Barco calibration software (MediCal QAWeb Agent, Kortrijk, Belgium) using the DICOM GSDF luminance response test. A Society of Motion Picture and Television Engineers file gray-scale display function standard (https://rad.esmil.com/reference/monitor%20test%20 patterns.htm) and a calibrated photometer (RaySafe Xi light detector, Billdal, Sweden) were used to measure the luminance ratio of 756:1, as this recorded a M AE SD L max (luminance maximum) of 492 AE 2 cd∕m 2 and M AE SD L min (luminance minimum) of 0.65 AE 0.02 cd∕m 2 . Room illuminance measured a M AE SD of 680 AE 27 lux.…”

“…9 VGC analysis involves image quality ratings data for the two conditions (a reference and test condition) that are compared to produce a VGC curve, which is analogous to the rating data (for normal and abnormal cases) in ROC analysis when developing an ROC curve. 2,9 An AUC VGC not statistically separated from 0.5 would indicate that the image quality was rated similarly for both reference and test conditions. 9 A VGC curve is a relative comparison between two groups, and therefore, the AUC VGC does not provide information about the absolute quality of the two groups.…”

“…The visual search of these two observer groups in evaluating the relevant vascular anatomy should be congruent in assisting with the progress and treatment outcome of the interventional radiology procedure allowing for a reduction of the radiation dose to the patient where possible. 1,2 Visual grading characteristics (VGC) analysis was first described by Båth and Månsson 3 as a nonparametric rank-invariant statistical method for analyzing visual grading data. Image quality from a reference condition and a test condition are compared by producing a VGC curve, which is a plot of the proportion of ratings above a certain threshold for the test condition against the same proportion for the reference condition at various settings.…”

“…Interventional radiographers are responsible for the operation of the angiography system and imaging, and interventional radiologists perform the image-guided procedure using minimally invasive techniques and devices. The visual search of these two observer groups in evaluating the relevant vascular anatomy should be congruent in assisting with the progress and treatment outcome of the interventional radiology procedure allowing for a reduction of the radiation dose to the patient where possible 1 , 2 . Visual grading characteristics (VGC) analysis was first described by Båth and Månsson 3 as a nonparametric rank-invariant statistical method for analyzing visual grading data.…”

Predictors of radiation dose for uterine artery embolisation are angiography system-dependent

“…(25) However, the upgraded system no longer records LIH dose or saved fluoroscopy information in contrast to its previous generation. There is a paucity of literature based on the formulation of regression models for UAE (25)(26)(27) or the application of the identified radiation dose predictors to optimise UAE practice (28) . Previous UAE regression models (25)(26)(27) were based on different angiography systems and sets of radiation dose predictor variables and could not be applied to this study.…”