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Tal MG, Keidar R, Magnazi G, Henn O, Kim JH, Chudnoff SG, Stepp KJ. Pressure-Induced Fibroid Ischemia: First-In-Human Experience with a Novel Device for Laparoscopic Treatment of Symptomatic Uterine Fibroids. Reprod Sci 2023; 30:1366-1375. [PMID: 35941511 PMCID: PMC9360636 DOI: 10.1007/s43032-022-01033-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to assess the feasibility of use of a novel uterine fibroid treatment device hypothesized to cause fibroid infarction by increasing intra-tumoral pressure. Between August 2019 and January 2020, 21 uterine fibroids were treated in 16 symptomatic pre-menopausal black women. Pelvic magnetic resonance imaging was performed before the procedure, a day after the procedure and at 1, 3, 6, and 12 months. The subjects were also followed for clinical outcomes and quality of life up to 12 months at a single investigational site. At 3 months, the mean reduction in the fibroid volume was 36.3% (P = .002). Incremental reduction in volume peaked at the end of the follow-up, at the 12-month mark (60.4%; P = .008). There were no procedures in which the users failed to perform laparoscopic pressure suturing of fibroids with the pressure-induced fibroid ischemia device. Improvement in the quality of life was evident in the Health-Related Quality of Life total, Energy/Mood, Control, and Sexual Function domains of the Uterine Fibroid Symptom and Quality of Life questionnaire at 3 months post-procedure. Unanticipated risks were not identified. Serious adverse events were not identified. The initial clinical assessment of the pressure-induced fibroid ischemia device supports feasibility of the approach and does not reveal serious safety concerns. Trial is currently being registered retrospectively (This was a feasibility study and therefore registration was not mandatory).
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Affiliation(s)
- Michael G Tal
- Division of Interventional Radiology, Hadassah Medical Center, Jerusalem, Israel.
| | - Ran Keidar
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Ohad Henn
- Empress Medical Ltd., Tel Aviv, Israel
| | - Jin Hee Kim
- Department of Obstetrics & Gynecology, Columbia University, New York, NY, USA
| | - Scott G Chudnoff
- Obstetrics and Gynecology, Maimonides Medical Center, New York, NY, USA
| | - Kevin J Stepp
- Atrium Health Women's Care Urogynecology and Pelvic Surgery, Atrium Health, Charlotte, NC, USA
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Pyra K, Szmygin M, Szmygin H, Woźniak S, Jargiełło T. Unilateral Uterine Artery Embolization as a Treatment for Patients with Symptomatic Fibroids-Experience in a Case Series. Medicina (B Aires) 2022; 58:medicina58121732. [PMID: 36556934 PMCID: PMC9783256 DOI: 10.3390/medicina58121732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives: Uterine artery embolization (UAE) has become an accepted and widely performed therapy for patients with symptomatic (reporting at least two of the following symptoms: severe or prolonged menstrual bleeding, abdominal pain, tension in abdomen, problems with urination, constipation or anemia) uterine fibroids. Although in the majority of cases, bilateral occlusion is required to obtain a successful clinical outcome, there are patients in whom treatment of only one uterine artery could be attempted. There are several reasons for unilateral UAE: hemodynamic conditions, technical difficulties, anatomical variants and unilateral dominancy of blood supply to the fibroid. Our aim is to present our 10-year experience with unilateral UAE and evaluate the radiological and clinical outcomes. Materials and Methods: Records of 369 patients with fibroids who underwent UAE from 2010 to 2021 were analyzed. We identified 26 patients treated with unilateral uterine artery embolization and analyzed the data of these patients. All patients attended medical consultation, were assessed using a five-grade symptom scale and underwent MRI examination. Clinical response was evaluated at least 6 months after the procedure and was categorized to one of the following groups: complete improvement, partial improvement, no change and a worsening in symptoms. Results: Twenty-two patients (85%) reported at least partial improvement 6 months following the procedure. One patient required secondary embolization due to recanalization. The secondary procedure was successful, and complete improvement was achieved. One patient did not observe any clinical improvement, and in two cases, symptom recurrence was observed. All three patients were referred for surgical treatment. No major complications were noted. Overall, the success rate was 88%. Conclusions: The results of our study support the statement that elective unilateral embolization is an appropriate treatment in patients with a dominant uterine artery.
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Affiliation(s)
- Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Str., 20-090 Lublin, Poland
| | - Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Str., 20-090 Lublin, Poland
- Correspondence: ; Tel.: +48-509-679-033
| | - Hanna Szmygin
- Department of Endocrinology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Sławomir Woźniak
- 3rd Department of Gynecology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8 Str., 20-090 Lublin, Poland
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Kim HO, Lee BC, Park C, Kim JK, Park WJ, Lee JE, Lim HS, Jeong WG. Occupational dose and associated factors during transarterial chemoembolization of hepatocellular carcinoma using real-time dosimetry: A simple way to reduce radiation exposure. Medicine (Baltimore) 2022; 101:e28744. [PMID: 35089250 PMCID: PMC8797565 DOI: 10.1097/md.0000000000028744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 01/12/2022] [Indexed: 01/05/2023] Open
Abstract
Transarterial chemoembolization is the standard treatment option for intermediate-stage hepatocellular carcinoma (HCC). However, during the interventional procedure, occupational radiation protection is compromised. The use of real-time radiation dosimetry could provide instantaneous radiation doses. This study aimed to evaluate the occupational dose of the medical staff using a real-time radiation dosimeter during transarterial chemoembolization (TACE) for HCC, and to investigate factors affecting the radiation exposure dose.This retrospective observational study included 70 patients (mean age: 66 years; age range: 38-88 years; male: female = 59: 11) who underwent TACE using real-time radiation dosimetry systems between August 2018 and February 2019. Radiation exposure doses of operators, assistants, and technicians were evaluated. Patients' clinical, imaging, and procedural information was analyzed.The mean dose-area product (DAP) and fluoroscopy time during TACE were 66.72 ± 55.14 Gycm2 and 12.03 ± 5.95 minutes, respectively. The mean radiation exposure doses were 24.8 ± 19.5, 2.0 ± 2.2, and 1.65 ± 2.0 μSv for operators, assistants, and technicians, respectively. The radiation exposure of the operators was significantly higher than that of the assistants or technicians (P < .001). The perpendicular position of the adjustable upper-body lead protector (AULP) on the table was one factor reducing in the radiation exposure of the assistants (P < .001) and technicians (P = .040). The DAP was a risk factor for the radiation exposure of the operators (P = .003) and technicians (P < .001).Occupational doses during TACE are affected by DAP and AULP positioning. Placing the AULP in the perpendicular position during fluoroscopy could be a simple and effective way to reduce the radiation exposure of the staff. As the occupational dose influencing factors vary by region or institution, further study is needed.
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Affiliation(s)
- Hyoung Ook Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Byung Chan Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Chan Park
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Jae Kyu Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Won-Ju Park
- Department of Occupational and Environmental Medicine, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Jong Eun Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Hyo Soon Lim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Won Gi Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, Republic of Korea
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Nocum DJ, Robinson J, Halaki M, Båth M, Thompson JD, Thompson N, Moscova M, Liang E, Mekiš N, Reed W. Predictors of radiation dose for uterine artery embolisation are angiography system-dependent. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:011502. [PMID: 34985415 DOI: 10.1088/1361-6498/ac480b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/04/2022] [Indexed: 06/14/2023]
Abstract
This study sought to achieve radiation dose reductions for patients receiving uterine artery embolisation (UAE) by evaluating radiation dose measurements for the preceding generation (Allura) and upgraded (Azurion) angiography system. Previous UAE regression models in the literature could not be applied to this centre's practice due to being based on different angiography systems and radiation dose predictor variables. The aims of this study were to establish whether radiation dose is reduced with the upgraded angiography system and to develop a regression model to determine predictors of radiation dose specific to the upgraded angiography system. A comparison between Group I (Allura,n= 95) and Group II (Azurion,n= 95) demonstrated a significant reduction in kerma-area product (KAP) and Ka, r (reference air kerma) by 63% (143.2 Gy cm2vs 52.9 Gy cm2;P< 0.001,d= 0.8) and 67% (0.6 Gy vs 0.2 Gy;P< 0.001,d= 0.8), respectively. The multivariable linear regression (MLR) model identified the UAE radiation dose predictors for KAP on the upgraded angiography system as total fluoroscopy dose, Ka, r, and total uterus volume. The predictive accuracy of the MLR model was assessed using a Bland-Altman plot. The mean difference was 0.39 Gy cm2and the limits of agreement were +28.49 and -27.71 Gy cm2, and thus illustrated no proportional bias. The resultant MLR model was considered system-dependent and validated the upgraded angiography system and its advance capabilities to significantly reduce radiation dose. Interventional radiologist and interventional radiographer familiarisation of the system's features and the implementation of the newly established MLR model would further facilitate dose optimisation for all centres performing UAE procedures using the upgraded angiography system.
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Affiliation(s)
- Don J Nocum
- SAN Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John Robinson
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Halaki
- Discipline of Exercise and Sport Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Magnus Båth
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-413 45, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - John D Thompson
- Department of Radiography, School of Health and Society, University of Salford, Salford M6 6PU, United Kingdom
| | - Nadine Thompson
- SAN Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
- School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michelle Moscova
- Faculty of Medicine and Health, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Eisen Liang
- SAN Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
- Sydney Fibroid Clinic, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
| | - Nejc Mekiš
- Medical Imaging and Radiotherapy Department, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Warren Reed
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Nocum DJ, Robinson J, Halaki M, Liang E, Thompson N, Moscova M, Reed W. Identifying predictors of patient radiation dose during uterine artery embolisation. J Med Radiat Sci 2021; 68:131-138. [PMID: 33185033 PMCID: PMC8168071 DOI: 10.1002/jmrs.450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Uterine artery embolisation (UAE) is regarded as a safe and effective treatment for symptomatic uterine fibroids and/or adenomyosis. Dose reduction during UAE is critical for this reproductive-age patient population to minimise the risks of radiation-induced effects. The aim of this study was to identify the predictors of radiation dose which can be controlled and optimised for patients during UAE. METHODS A total of 150 patients between June 2018 and August 2019 were included in this study. Demographic and clinical information such as age, body mass index (BMI), total number of fibroids, total fibroid volume, total uterus volume and dosimetric measurements on Dose Area Product (DAP), Air Kerma (AK) and fluoroscopy time were recorded. Total digital subtraction angiography (DSA), total conventional roadmap (CRM), total last-image hold (LIH) and total fluoroscopy were calculated from the dose report. Multiple linear regression analysis was used to identify the independent predictor variables of total dose (DAP) using a regression model. RESULTS Total DSA, total CRM and total LIH were identified as the determinants of dose for UAE (P < 0.05) and together accounted for 95.2% of the variance. CONCLUSIONS This study identified the key imaging predictors of dose for UAE. Total DSA, total CRM and total LIH were shown to have a greater impact on the outcome DAP compared to other demographic or dosimetric measurements. Optimisation of these predictors during future UAE procedures can facilitate radiation dose reduction to the pelvis and reproductive organs.
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Affiliation(s)
- Don J. Nocum
- San Radiology & Nuclear MedicineSydney Adventist HospitalWahroongaNew South WalesAustralia
- Discipline of Medical Imaging ScienceSchool of Health Sciences, Faculty of Medicine and HealthThe University of SydneyNew South WalesAustralia
| | - John Robinson
- Discipline of Medical Imaging ScienceSchool of Health Sciences, Faculty of Medicine and HealthThe University of SydneyNew South WalesAustralia
| | - Mark Halaki
- Discipline of Exercise and Sports ScienceSchool of Health Sciences, Faculty of Medicine and HealthThe University of SydneyNew South WalesAustralia
| | - Eisen Liang
- Department of RadiologySydney Adventist Hospital Clinical SchoolUniversity of SydneyWahroongaNew South WalesAustralia
| | - Nadine Thompson
- San Radiology & Nuclear MedicineSydney Adventist HospitalWahroongaNew South WalesAustralia
- Department of RadiologySydney Adventist Hospital Clinical SchoolUniversity of SydneyWahroongaNew South WalesAustralia
| | - Michelle Moscova
- Faculty of MedicineSchool of Medical SciencesUniversity of New South WalesNew South WalesAustralia
| | - Warren Reed
- Discipline of Medical Imaging ScienceSchool of Health Sciences, Faculty of Medicine and HealthThe University of SydneyNew South WalesAustralia
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Souza SP, Silva MF, Tavares OJ, Souza LWG, Silva DC, Santos WS, Belinato W, Perini AP, Neves LP. Monte Carlo evaluation of occupational exposure during uterine artery embolization. Phys Med 2021; 85:50-56. [PMID: 33965741 DOI: 10.1016/j.ejmp.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Uterine fibroids affect women mainly of childbearing age, an alternative for the treatment of these fibroids is uterine artery embolization (UAE), a minimally invasive procedure which uses fluoroscopy, providing radiation doses often high, due to the fact that professionals remain in the room throughout the procedure. In this work, equivalent and effective doses were evaluated for the main physician, for the assistant and for the patient during the UAE procedure. METHODS Doses were calculated using computer simulation with the Monte Carlo Method, and virtual anthropomorphic phantoms, in a typical scenario of interventional radiology with field sizes of 20 × 20, 25 × 25 and 32 × 32 cm2, tube voltages of 70, 80, 90 and 100 kV, and projections of LAO45, RAO45 and PA. RESULTS The results showed that the highest doses received by the professionals were for the LAO45 projection with 32 × 32 cm2 field size and 100 kV tube voltage, which is in accordance with the existing literature. The highest equivalent doses, without the protective equipment, were in the eyes, skin, breast and stomach for the main physician, and for the assistant they were in the eyes, breast, thyroid and skin. When she used the protective equipment, the highest equivalent doses for the main physician were on the skin, brain, bone marrow and bone surface, and for the assistant they were on the skin, brain, red bone marrow and bone surface. CONCLUSIONS Effective doses increased up to 3186% for the main physician, and 2462% for the assistant, without protective equipment, thus showing their importance.
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Affiliation(s)
- Samara P Souza
- Programa de Pós-Graduação em Engenharia Biomédica, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia, MG, Brazil
| | - Monique F Silva
- Programa de Pós-Graduação em Engenharia Biomédica, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia, MG, Brazil
| | - Otávio J Tavares
- Programa de Pós-Graduação em Engenharia Biomédica, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia, MG, Brazil
| | - Lucas W G Souza
- Programa de Pós-Graduação em Engenharia Biomédica, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia, MG, Brazil; Instituto Maria Ranulfa Ltda, FATRA - Faculdade do Trabalho, Av. Paes Leme Osvaldo, 38408000 Uberlândia, MG, Brazil
| | - Daniela C Silva
- Programa de Pós-Graduação em Engenharia Biomédica, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia, MG, Brazil
| | - William S Santos
- Instituto de Física, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Walmir Belinato
- Instituto Federal da Bahia (IFBA), Vitória da Conquista, BA, Brazil
| | - Ana P Perini
- Programa de Pós-Graduação em Engenharia Biomédica, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia, MG, Brazil; Instituto de Física, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Lucio P Neves
- Programa de Pós-Graduação em Engenharia Biomédica, Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia, MG, Brazil; Instituto de Física, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil.
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