Method of Reducing Radiation Exposure to the Physician during X-ray Endovascular Embolization of Uterine Arteries

Objective. Every day in order to reduce the risk of complications and for early activation of the patient, interest in minimally invasive surgery is growing. One of these areas is X-ray endovascular surgery. It’s quite universal and high-effective, safe and low-traumatic. However, daily work in X-ray conditions is associated with the risk of occupational pathology among medical workers. Accordingly, we proposed a method of special patient positioning to reduce the radiation dose to medical staff. The choice of access is important for transcatheter interventions, in particular uterine artery embolization (UAE). Currently, transradial access is considered preferable, characterized by a low risk of vascular complications compared to traditional transfemoral access and allowing to reduce procedure time and radiation exposure for healthcare workers and patients.

Materials and methods. A prospective analysis of 20 patients was conducted at the Medical Unit of the Kazan Federal University. The patients were randomized into 2 groups: 10 patients underwent UAE via transradial access with standard positioning and 10 patients positioning the lower extremities to the C-arm of the angiographic complex. Indications for UAE were uterine fibroids with clinical manifestations. The patients underwent selective bilateral step-by-step catheterization and angiography of the uterine arteries in a direct projection without C-arm angulation in the DSA Body 4 CARE mode, followed by alternate embolization with 500–900 μm microspheres until stasis of the contrast agent was achieved in distal segments of uterine arteries. During radiation monitoring in the X-ray room procedure room, measurements were carried out using a highly sensitive compact X-ray and gamma radiation dosimeter DKS-AT 1123 at the surgeon’s workplace at 4 main points.

Results. In standard laying the average equivalent dose rate (EDR) value in the operating room of the doctor-operator during radiography was: min EDR 1.881 μSv/h, max EDR — 3.998 μSv/h, during fluoroscopy: min EDR — 0.518 μSv/h, max EDR — 1.088 μSv/h. When laying with lower limbs to the C-arc, the average EDR value in the operating room of the operating physician during radiography was: min EDR — 0.293 μSv/h, max EDR — 0.745 μSv/h, during fluoroscopy: min EDR of the personnel — 0.143 μSv/h, max EDR of the personnel — 0.257 μSv/h.

Conclusion. Using a fundamentally new installation method, it was possible to significantly reduce the radiation dose to the operator, thereby minimizing the risks of professional pathologies of interventional radiologists.

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