Mauro Campoleoni BS, Presenter: Nothing to Disclose

Antonio Nicolini MD, Abstract Co-Author: Nothing to Disclose

Irene Fulgheri, Abstract Co-Author: Nothing to Disclose

Andrea Avagliano, Abstract Co-Author: Nothing to Disclose

Cristian Bonelli, Abstract Co-Author: Nothing to Disclose

The procedure is safe. The two methods used for dose evaluation give similar results. When the use of fluoroscopy is optimized, fetal dose can be contained to a minimum, taking care, particularly, of a correct positioning (patient far from the tube and close to the detector) careful collimation, the use of a well filtered X-ray beam and the lowest possible pulse rate.

Placental developmental abnormalities are among the worst post partum complications and can lead to severe hemorrhages, emergency hysterectomy and to several disorders like disseminated intravascular coagulation (DIC). In recent years, prophylactic uterine arterial embolization (UAE) has been proposed in order to reduce hemorrhagic risks. Up to now, this technique hasn’t been clearly coded, and can include a fluoroscopy guided bilateral positioning of catheters in both the uterine arteries before the cesarean section, and this exposes the fetus to a certain amount of radiation dose. The purpose of this study was to evaluate the absorbed dose to the fetus for patients undergoing fluoroscopy imaging during this prophylactic catheterization, according to a specific protocol, and study optimized exposure parameters.  

The procedure was successfully conducted on 10 patients with a gestational age (GA) higher than 34 weeks, 8 with placenta previa and 2 with placenta accreta. Two different methods were used to evaluate fetal doses: - measurements of Entrance Skin Dose (ESD) with thermoluminescent dosimeters at skin entrance in the X-ray field, applying then conversion factors from ESD to the average uterus dose; - calculation of ESD from basic physical data (Dose Area Product, DAP and Source to Skin Distance, SSD) applying then a validated model (software FetDose v.4). A few simulations were made to better measure dose rates according to the pulse rate used.  

The average fluoroscopy time was 20 s (13 – 27), the mean DAP 93.9 cGy*cm2 (64 - 123), the mean Entrance Skin Dose 10.4 mGy (7.5 – 15.1). The average fetal doses resulted in 2.58 mGy (0.9-4.53) and 1.98 mGy (1.01 – 2.96) according to the two different methods respectively.

Campoleoni, M, Nicolini, A, Fulgheri, I, Avagliano, A, Bonelli, C, Evaluation of Radiation Dose to the Conceptus in Prophylactic Uterine Arterial Embolization.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013717.html