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

Don J Nocum; John Robinson; Mark Halaki; Magnus Båth; John D Thompson; Nadine Thompson; Michelle Moscova; Eisen Liang; Nejc Mekiš; Warren Reed

doi:10.1088/1361-6498/ac480b

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

J Radiol Prot. 2022 Jan 17;42(1). doi: 10.1088/1361-6498/ac480b.

Authors

Don J Nocum^{1

2}, John Robinson^{2

3}, Mark Halaki⁴, Magnus Båth^{5

6}, John D Thompson⁷, Nadine Thompson^{1

8}, Michelle Moscova⁹, Eisen Liang^{1

10}, Nejc Mekiš¹¹, Warren Reed^{2

3}

Affiliations

¹ SAN Radiology & Nuclear Medicine, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia.
² Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
³ 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.
⁴ 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.
⁵ Department of Medical Radiation Sciences, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-413 45, Sweden.
⁶ Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
⁷ Department of Radiography, School of Health and Society, University of Salford, Salford M6 6PU, United Kingdom.
⁸ School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
⁹ Faculty of Medicine and Health, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.
¹⁰ Sydney Fibroid Clinic, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia.
¹¹ Medical Imaging and Radiotherapy Department, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia.

PMID: 34985415
DOI: 10.1088/1361-6498/ac480b

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.

Keywords: Bland-Altman plot; dose optimisation; multivariable linear regression; radiation dose; regression model; uterine artery embolisation.

MeSH terms

Angiography
Female
Fluoroscopy
Humans
Radiation Dosage
Radiography, Interventional
Uterine Artery Embolization*