An optimized angiographic protocol is associated with lower radiation exposure during uterine artery embolization in a retrospective before-after cohort study

Abstract This single-center retrospective before–after cohort study evaluated whether an optimized angiographic protocol is associated with reduced radiation exposure during uterine artery embolization (UAE). The optimized protocol included (i) direct selective catheterization under roadmap guidance, (ii) omission of routine non-selective aorto-iliac angiography, and (iii) hand-injection fluoroscopic assessment after embolization. Ninety consecutive UAE procedures were compared across a chronological protocol change (conventional vs. optimized), and outcomes were also explored by femoral access route (right n = 44, left n = 46; the higher-than-expected proportion of left access reflects our institution’s tertiary referral case-mix and operators’ bilateral proficiency) because access was selected on anatomical grounds. The optimized protocol was associated with a 40.0% lower dose–area product (DAP) (geometric mean ratio [GMR] 0.60, 95% CI 0.57–0.64). Dose reduction was observed within both access-route subgroups (36.0% for right access and 43.0% for left access). The protocol effect did not differ clearly by access route (ratio of GMRs 0.89, 95% CI 0.78–1.02), although this access-route comparison remains exploratory; a sensitivity analysis restricted to the routine right-access cohort yielded a consistent estimate (adjusted GMR 0.65, 95% CI 0.60–0.70). Cumulative reference air kerma and contrast volume decreased under the optimized protocol, while fluoroscopy time was unchanged. Independent review showed slightly lower overall diagnostic adequacy for optimized procedures, defined as scoring ≥ 3 across all five predefined imaging domains (95.6% conventional vs. 88.9% optimized; risk difference − 6.7%, 95% CI − 18.9 to + 5.1); however, this comparison was not powered to exclude a clinically relevant loss of diagnostic information. In conclusion, optimized angiographic imaging was associated with substantially reduced dosimetric exposure during UAE, but prospective studies are needed to determine whether the dosimetric benefit translates into clinical advantage.