Radiation Dose From Uterine Artery Embolization Procedures: A Single Center Study

Ahmed Almutairi1, Khaled Soliman1, Murdhi Alharbi1, Khaleel Almutairi1, Turkey Almutairi1

1 Prince Sultan Military Medical City, Riyadh, Saudi Arabia.di Arabia.

Conflict-of-interest statement: The author(s) declare(s) that there is no conflict of interest regarding the publication of this paper.

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Correspondence to: Khaled Soliman, PhD, DABMP, Prince Sultan Military Medical City, Riyadh, Saudi Arabia. P.o. box 7897, Riyadh 11159.
Email: Khaledsoliman61@gmail.com
Telephone: +966 507833612
Fax: +966 011 2063001
ORCID ID: https//orcid.org/0000-0003-1008-6103

Received: April 28, 2021
Revised: May 20, 2021
Accepted: May 23, 2021
Published online: June 8, 2021


AIM: To establish a local radiation dose reference level for utrine artery embolization procedures conducted at a large tertiary care medical city; and to benchmark our data with the internatioinally publisged reference levels worldwide.

MATERIALS AND METHODS: In this work analysis was performed on the available data from the modality dose report obtained by the imaging system at the end of the procedure for eighty four patients, and archived in the picture archiving and communication system (PACS).

RESULTS: We have found a median PKA value of 347 [Gy.cm2] for 84 UAE procedures conducted in our medical center. Comparisons with the internationally published data are discussed.

CONCLUSIONS: The reported patient PKA are comparable with internationally reported studies and current trends. The medical use of x-ray imaging during interventional procedures is a safe practice for all categories of involved personnel including the patients. Further deeper analysis of the factors affecting the levels of radiation dose is recommended.such analysis will allow potential optimization of the procedure.

Key words: Uterine artery emblization; Air kerma area product; Patient radiation dose; Interventional radiology

© 2021 The Author(s). Published by ACT Publishing Group Ltd. All rights reserved.

Almutairi A, Soliman K, Alharbi M, Almutairi K, Almutairi T. Radiation Dose From Uterine Artery Embolization Procedures: A Single Center Study. International Journal of Radiology 2021; 8(1): 267-269 Available from: URL: http://www.ghrnet.org/index.php/ijr/article/view/3166


The number of procedures utilizing image guided noninvasive interventions is increasing, therefore attention must be paid to closely monitor both patients and staff radiation doses as results of that increase. regular application of radiation protection measures plays an important role in ensuring that patients doses are optimized.

During the last decade the number, complexity and variety of interventions using fluoroscopy guidance has increased. Radiation protection regulations requires routine monitoring of radiation doses received by patientsundergoing interventional procedures using fluoroscopy guidance.

Uterine artery embolization (UAE) is a minimal invasive procedure that requires fluoroscopic and angiographic imaging and this causes a concern regarding the radiation dose received by the patient during the intervention. It is known that angiographic imaging systems can deliver a significant amount of radiation to the patient’s skin; therefore radiation dose monitoring is required[1].


UAE procedure is a minimally invasive procedure performed under fluoroscopic guidance in Interventional Radiology Department. A catheter is introduced to the sheath that is inserted either in radial or femoral arteries, the micro-catheter is then placed in the uterine artery and embolic agents is injected to block the artery in order to prevent hemorrhages and cut off blood supplies to uterine fibroids. The routine fluoroscopy pulse rate used in our institution is 10 pulses/sec, maximum collimation is applied at all times and angulation projections are routinely used.

In this study we have retrospectively collected from the angiographic system registered dose report data concerning 84 patients who underwent UAE procedures in 2019. Radiation dose indicators such as, the fluoroscopy time (FT) in minutes, the cumulative kerma area product (PKA) in [Gy.cm2], the cumulative reference air kerma (Ka,r) in [mGy]. We used a biplane system C-arm with flat detector angiography, AXIOM Artis dBA (Siemens, Erlangen, Germany) to conduct the UAE procedures.

Figure 1 Cumulative PKA in [Gy.cm2] as a function of Ka,r in [mGy].

Table 1 summary of patient and radiation dose metrics
  Time [min]PKA [Gy.cm2]Ka,r [mGy]
standard deviation15.63041878
Coeff of variation0.560.870.89

Table 2 comparison of this study with few of the reported PKA values in the literature
AuthorYearPKA [Gy.cm2]Ka,r [Gy]n
Ruiz-Cruz2016214 56
Durrani2016437 (267) *  
Kohlbrenner2017438 (175) *  
Schernthaner2018527 (146) *  
This study20203472.1100
The values in parentheses are the values obtained after applying imaging system optimization.:*


As expected a linear regression relationship was found between the cumulative air kerma measured at the reference point (Ka,r) and the cumulated kerma area product (PKA). Figure 1 shows the relationship between PKA and Ka,r. Equation 1 has the mathematical relationship between PKA and Ka,r that was found for the angiographic imaging system used in this study: PKA [Gy.cm2] = 84.6 + 0.125 Ka,r [mGy] (R = 0.779, p < 0.001)[1].

There are a number of published studies reporting radiation dose assessments and dose reduction and optimization techniques [2-7]. The reported values of PKA are in table 4. In this study we have found a median PKA value of 347 [Gy.cm2] for 84 UAE procedures conducted in our medical center.


Comparing radiation dose values and dosimetric quantities among published studies are very difficult because the procedures identification are not standardized and also their complexity vary considerably and there is no classification for procedures in accordance with their respective complexity level[8]. Therefore there is always a need to perform regular local clinical dose audits. In this work we have analyzed available patient dose related metrics with the aim of identifying the metrics or variables that affect the most the patient radiation exposure represented by the kerma area product during UAE.

The recommended DRL for UAE was set at 450 [Gy.cm2] and the reported 75th percentile PKA from the radiation doses in interventional radiology procedures study (RAD-IR) data was 392 [Gy.cm2][2].

Procedures with DAP values above 300 [Gy.cm2] should be optimized if possible. A recent study suggests to use a DAP value of 50 Gy.cm2 as target value for UAE procedures. in this study the authors suggested strategies for reducing radiation exposure during UAE; the strategies included: optimized source-image and object-image distances, avoidance of magnification, use of tight collimation, use of road-mapping, avoidance of oblique projections, use pulsed fluoroscopy with low images per second, use low frame rates, use last-image-hold and avoid 3D rotational angiography[9].

The use of optimization strategies will reduce the radiation dose received by the patients as well as the staff performing the procedure especially in cases expected to lead to a higher than usual radiation dose like for obese patients[10].


The reported occupational doses in interventional radiology including fluoroscopically guided procedures was well below the ICRP recommended annual dose limit of 20 mSv. The obtained results are in agreement with internationally reported studies and current trends. The medical use of x-ray imaging during interventional procedures is a safe practice for all categories of involved personnel when close adherence to basic radiation protection methods are observed.


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