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Awareness of uterine fibroid embolization (UFE) as a treatment option for uterine fibroids in a community-based practice
S138
’
Wednesday
4:24 PM
Scientific Session
Abstract No. 302
Awareness of uterine fibroid embolization (UFE) as a treatment option for uterine fibroids in a community-based practice J. Lipman, MD, FACR ; Atlanta Interventional Institute, Atlanta, GA Purpose: To evaluate awareness of UFE as a treatment option for fibroids during initial Gynecology consultation for symptomatic fibroids. Materials and Methods: Between July 1, 2014 and September 30, 2014, 83 women that were new patient consultations for possible UFE were asked 6 questions at the start of their consult. These questions centered on the chief complaint(s), origin of the referral, and whether or not the patient was informed about UFE as a potential treatment option. Results: Most of the patients were self-referred. The majority of these patients presented with the three main symptoms of symptomatic fibroids: menorrhagia, pelvic pain, and increased urinary frequency. Over three-quarters of the patients surveyed said that their Gynecologist failed to mention UFE as a potential treatment option initially. Most patients did eventually discuss UFE with their Gynecologist and most of these patients were left with the impression that their Gynecologist was not in favor of UFE. All of the respondents that were not told initially about UFE by their Gynecologist felt that UFE should have been discussed initially with them as a potential treatment option. Conclusion: Despite the requirement for informed consent for all patients under medical procedures, most patients with symptomatic fibroids in this study were not informed of UFE as a potential treatment option at their initial gynecology consultation.
4:33 PM
Abstract No. 303
Variability in the radiation dose associated with uterine embolization for fibroids
WEDNESDAY: Scientific Sessions
S.S. Khera, J.B. Spies; Radiology, Georgetown University Medical Center, Washington, DC Purpose: To determine which patient specific factors influence patient radiation dose during the uterine fibroid embolization (UFE). Materials and Methods: Data from 516 consecutive patients undergoing UFE procedure were reviewed. Radiation exposure factors collected were: kerma air product, point air kerma and fluoroscopy time. Other variables were procedure-related (operator, duration, and suite), patient age, body mass index (BMI), uterine volume, and dominant fibroid volume. Descriptive and summary statistics were used to analyze data with univariate regression analyses to determine predictors of each of patient exposure factors. We log transformed kerma air product and point air kerma to remove the skewness for regression analysis. Results: The mean of fluoroscopy time, kerma air product and point air kerma were 14.6⫾6.5 min, 10759.3⫾10021.5 mGy-m2 and 671.8⫾627.4 mGy respectively. In addition, the mean of BMI, uterus volume, fibroid volume and procedure duration were 29.4⫾6.9 kg/m2, 689.5⫾524.9, 171⫾194.4 and 64.2⫾28.8 minutes respectively. BMI had a significant effect on kerma air product and point air kerma. One unit increase in BMI increased kerma air product and point air kerma by 8 percent, p value o
’
JVIR
0.0001. BMI explained 49% of the total variation in kerma air product and 42% of the total variation in point air kerma. Uterus volume and fibroid volume had a small but significant effect on kerma air product. One unit increase in uterus volume or fibroid volume increased kerma air product by 0.06%, p value o 0.0001. Uterus volume also had a small but significant effect on point air kerma. One unit increase in uterus volume increased point are kerma by 0.04%, p value o0.0001. Fibroid volume did not have significant effect on point air kerma. Conclusion: Patients with high BMI undergoing UFE are exposed to higher radiation doses (kerma air product and point air kerma) and are at increased risk of radiation injury. Interventional radiologists should be aware of this significant increased radiation exposure when conducting UFE in obese patients and follow guidelines to minimize radiation exposure.
4:42 PM
Abstract No. 304
Using uterine or fibroid size to estimate embolic particle volume: is there a correlation? D. Semaan, A. Vyas, M. Osher, L.M. Vance; Radiology, St John Providence Hospital, Southfield, MI Purpose: Uterine Artery Embolization (UAE) is a widely accepted, minimally invasive, means of treating symptomatic leiomyomata, often foregoing the need of a traditional open and sometimes difficult hysterectomy. At our institution, it is common practice for a patient to undergo a contrast enhanced pelvic MRI to evaluate the extent, location and vascularity of the fibroids to determine if the patient would be suitable candidate for UAE. One would assume that as the volume of fibroid tissue increases, a greater amount of embolic particles would be required for adequate treatment. The purpose of this study is to evaluate if one can accurately estimate the volume of embolic particles required during a UAE based upon either the total volume of the uterus or alternatively the volume of the more dominant uterine fibroid, based on pre-procedure MRI measurements in an effort to decrease fluoroscopy time and thus radiation dose. Materials and Methods: This is a dual center retrospective analysis, wherein medical records and imaging from all UAE performed from August 1, 2008 to July 1, 2014 were reviewed. This query totaled 152 patients, of which 138 patients, of which, had pre-procedure MRI retrievable on our PACS system. The preprocedural volume of the uterus and dominant fibroid were calculated and compared to the amount of embolic particles used during the procedure. A multiple regression analysis was performed to assess the relationship between the volume of the total uterus and dominant fibroid to the volume of embolic particles utilized. Results: Neither the volume of uterus (R2¼0.18) nor dominant fibroid (R2¼0.02) demonstrated statistical significance in predicting the volume of embolic particles used during the procedure. Conclusion: Estimating the volume of embolic particles based on uterine or dominant fibroid volume proved unreliable in this study. The intention was to estimate the amount of embolic material needed to achieve stasis, therefore limiting the need for intermittent fluoroscopy during the injection. This study showed no statistical correlation between the size of the uterus or dominant fibroid and the volume of embolic particles used, therefore, neither serve as a reliable indicator.
’
Wednesday
4:24 PM
Scientific Session
Abstract No. 302
Awareness of uterine fibroid embolization (UFE) as a treatment option for uterine fibroids in a community-based practice J. Lipman, MD, FACR ; Atlanta Interventional Institute, Atlanta, GA Purpose: To evaluate awareness of UFE as a treatment option for fibroids during initial Gynecology consultation for symptomatic fibroids. Materials and Methods: Between July 1, 2014 and September 30, 2014, 83 women that were new patient consultations for possible UFE were asked 6 questions at the start of their consult. These questions centered on the chief complaint(s), origin of the referral, and whether or not the patient was informed about UFE as a potential treatment option. Results: Most of the patients were self-referred. The majority of these patients presented with the three main symptoms of symptomatic fibroids: menorrhagia, pelvic pain, and increased urinary frequency. Over three-quarters of the patients surveyed said that their Gynecologist failed to mention UFE as a potential treatment option initially. Most patients did eventually discuss UFE with their Gynecologist and most of these patients were left with the impression that their Gynecologist was not in favor of UFE. All of the respondents that were not told initially about UFE by their Gynecologist felt that UFE should have been discussed initially with them as a potential treatment option. Conclusion: Despite the requirement for informed consent for all patients under medical procedures, most patients with symptomatic fibroids in this study were not informed of UFE as a potential treatment option at their initial gynecology consultation.
4:33 PM
Abstract No. 303
Variability in the radiation dose associated with uterine embolization for fibroids
WEDNESDAY: Scientific Sessions
S.S. Khera, J.B. Spies; Radiology, Georgetown University Medical Center, Washington, DC Purpose: To determine which patient specific factors influence patient radiation dose during the uterine fibroid embolization (UFE). Materials and Methods: Data from 516 consecutive patients undergoing UFE procedure were reviewed. Radiation exposure factors collected were: kerma air product, point air kerma and fluoroscopy time. Other variables were procedure-related (operator, duration, and suite), patient age, body mass index (BMI), uterine volume, and dominant fibroid volume. Descriptive and summary statistics were used to analyze data with univariate regression analyses to determine predictors of each of patient exposure factors. We log transformed kerma air product and point air kerma to remove the skewness for regression analysis. Results: The mean of fluoroscopy time, kerma air product and point air kerma were 14.6⫾6.5 min, 10759.3⫾10021.5 mGy-m2 and 671.8⫾627.4 mGy respectively. In addition, the mean of BMI, uterus volume, fibroid volume and procedure duration were 29.4⫾6.9 kg/m2, 689.5⫾524.9, 171⫾194.4 and 64.2⫾28.8 minutes respectively. BMI had a significant effect on kerma air product and point air kerma. One unit increase in BMI increased kerma air product and point air kerma by 8 percent, p value o
’
JVIR
0.0001. BMI explained 49% of the total variation in kerma air product and 42% of the total variation in point air kerma. Uterus volume and fibroid volume had a small but significant effect on kerma air product. One unit increase in uterus volume or fibroid volume increased kerma air product by 0.06%, p value o 0.0001. Uterus volume also had a small but significant effect on point air kerma. One unit increase in uterus volume increased point are kerma by 0.04%, p value o0.0001. Fibroid volume did not have significant effect on point air kerma. Conclusion: Patients with high BMI undergoing UFE are exposed to higher radiation doses (kerma air product and point air kerma) and are at increased risk of radiation injury. Interventional radiologists should be aware of this significant increased radiation exposure when conducting UFE in obese patients and follow guidelines to minimize radiation exposure.
4:42 PM
Abstract No. 304
Using uterine or fibroid size to estimate embolic particle volume: is there a correlation? D. Semaan, A. Vyas, M. Osher, L.M. Vance; Radiology, St John Providence Hospital, Southfield, MI Purpose: Uterine Artery Embolization (UAE) is a widely accepted, minimally invasive, means of treating symptomatic leiomyomata, often foregoing the need of a traditional open and sometimes difficult hysterectomy. At our institution, it is common practice for a patient to undergo a contrast enhanced pelvic MRI to evaluate the extent, location and vascularity of the fibroids to determine if the patient would be suitable candidate for UAE. One would assume that as the volume of fibroid tissue increases, a greater amount of embolic particles would be required for adequate treatment. The purpose of this study is to evaluate if one can accurately estimate the volume of embolic particles required during a UAE based upon either the total volume of the uterus or alternatively the volume of the more dominant uterine fibroid, based on pre-procedure MRI measurements in an effort to decrease fluoroscopy time and thus radiation dose. Materials and Methods: This is a dual center retrospective analysis, wherein medical records and imaging from all UAE performed from August 1, 2008 to July 1, 2014 were reviewed. This query totaled 152 patients, of which 138 patients, of which, had pre-procedure MRI retrievable on our PACS system. The preprocedural volume of the uterus and dominant fibroid were calculated and compared to the amount of embolic particles used during the procedure. A multiple regression analysis was performed to assess the relationship between the volume of the total uterus and dominant fibroid to the volume of embolic particles utilized. Results: Neither the volume of uterus (R2¼0.18) nor dominant fibroid (R2¼0.02) demonstrated statistical significance in predicting the volume of embolic particles used during the procedure. Conclusion: Estimating the volume of embolic particles based on uterine or dominant fibroid volume proved unreliable in this study. The intention was to estimate the amount of embolic material needed to achieve stasis, therefore limiting the need for intermittent fluoroscopy during the injection. This study showed no statistical correlation between the size of the uterus or dominant fibroid and the volume of embolic particles used, therefore, neither serve as a reliable indicator.