Reproductive (ovaries, scrotum, uterus)
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Diagnostic Radiology
Ultrasound
Interventional Radiology (IR)
Obstetrical Ultrasound
- What is Obstetrical Ultrasound Imaging?
- What are some common uses of the procedure?
- How should I prepare?
- What does the equipment look like?
- How does the procedure work?
- How is the procedure performed?
- What will I experience during and after the procedure?
- Who interprets the results and how do I get them?
- What are the benefits vs. risks?
- What are the limitations of Obstetrical Ultrasound Imaging?
What is Obstetrical Ultrasound Imaging?
Ultrasound imaging, also called ultrasound scanning or sonography, involves exposing part of the body to high-frequency sound waves to produce pictures of the inside of the body. Ultrasound exams do not use ionizing radiation (as used in x-rays). Because ultrasound images are captured in real-time, they can show the structure and movement of the body's internal organs, as well as blood flowing through blood vessels.
Ultrasound imaging is a noninvasive medical test that helps physicians diagnose and treat medical conditions.
Obstetrical ultrasound provides pictures of an embryo or fetus within a woman's uterus, as well as the mother's uterus and ovaries.
A Doppler ultrasound study may be part of an obstetrical ultrasound examination.
Doppler ultrasound is a special ultrasound technique that evaluates blood flow through a blood vessel, including the body's major arteries and veins in the abdomen, arms, legs and neck.
During an obstetrical ultrasound the examiner may evaluate blood flow in the umbilical cord or may in some cases assess blood flow in the fetus or placenta.
What are some common uses of the procedure?
Obstetrical ultrasound is a useful clinical test to:
- establish the presence of a living embryo/fetus.
- estimate the age of the pregnancy.
- diagnose congenital abnormalities of the fetus.
- evaluate the position of the fetus.
- evaluate the position of the placenta.
- determine if there are multiple pregnancies.
- determine the amount of amniotic fluid around the baby.
- check for opening or shortening of the cervix or mouth of the womb.
- assess fetal growth.
- assess fetal well-being.
How should I prepare?
You should wear a loose-fitting, two-piece outfit for the examination. Only the lower abdominal area needs to be exposed during this procedure.
If an ultrasound is ordered by your clinician early in your pregnancy, you may be instructed to have a full bladder for the procedure. Air interferes with sound waves, so if your bladder is distended, the air-filled bowel is pushed out of the way by the bladder and an image of the uterus and embryo or fetus is obtained.
The radiologist or sonographer may elect to examine an early pregnancy by means oftransvaginal ultrasound. This requires an empty urinary bladder. You should ask for specific instructions for this imaging study when you make your appointment. For more information on transvaginal ultrasound, see the Pelvic Ultrasound page (www.RadiologyInfo.org/en/info.cfm?pg=pelvus).
What does the equipment look like?
Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer that is used to scan the body and blood vessels. The transducer is a small hand-held device that resembles a microphone, attached to the scanner by a cord. The transducer sends out high frequency sound waves into the body and then listens for the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and submarines.
The ultrasound image is immediately visible on a nearby video display screen that looks much like a computer or television monitor. The image is created based on the amplitude (strength), frequency and time it takes for the sound signal to return from the patient to the transducer and the type of body structure the sound travels through.
How does the procedure work?
Transabdominal transducer
Ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it bounces back, or echoes. By measuring these echo waves it is possible to determine how far away the object is and its size, shape, and consistency (whether the object is solid, filled with fluid, or both).
In medicine, ultrasound is used to detect changes in appearance of organs, tissues, and vessels or detect abnormal masses, such as tumors.
In an ultrasound examination, a transducer both sends the sound waves and records the echoing waves. When the transducer is pressed against the skin, it directs small pulses of inaudible, high-frequency sound waves into the body. As the sound waves bounce off of internal organs, fluids and tissues, the sensitive microphone in the transducer records tiny changes in the sound's pitch and direction. These signature waves are instantly measured and displayed by a computer, which in turn creates a real-time picture on the monitor. One or more frames of the moving pictures are typically captured as still images.
The movement of the embryo or fetus and his or her heartbeat can be seen as an ongoing ultrasound movie. Most ultrasound devices also have an audio component that processes the echoes produced by blood flowing through the fetal heart, blood vessels and umbilical cord. This sound can be made audible to human ears and has been described by patients as a whooshing noise.
Doppler ultrasound, a special application of ultrasound, measures the direction and speed of blood cells as they move through vessels. The movement of blood cells causes a change in pitch of the reflected sound waves (called the Doppler effect). A computer collects and processes the sounds and creates graphs or color pictures that represent the flow of blood through the blood vessels.
How is the procedure performed?
For most ultrasound exams, the patient is positioned lying face-up on an examination table that can be tilted or moved.
A clear water-based gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin. The sonographer (ultrasound technologist) or radiologist then presses the transducer firmly against the skin in various locations, sweeping over the area of interest or angling the sound beam from a farther location to better see an area of concern.
Sometimes the radiologist determines that a transvaginal scan needs to be performed. This technique often provides improved, more detailed images of the uterus andovaries. This method of scanning is especially useful in early pregnancy.
Transvaginal transducer
Transvaginal ultrasound is performed very much like a gynecologic exam and involves the insertion of the transducer into the vagina after the patient empties her bladder. The tip of the transducer is smaller than the standard speculum used when performing a Pap test. A protective cover is placed over the transducer, lubricated with a small amount of gel, and then inserted into the vagina. Only two to three inches of the transducer end are inserted into the vagina. The images are obtained from different orientations to get the best views of the uterus and ovaries. Transvaginal ultrasound is usually performed with the patient lying on her back, possibly with her feet in stirrups similar to a gynecologic exam.
Doppler sonography is performed using the same transducer.
When the examination is complete, the patient may be asked to dress and wait while the ultrasound images are reviewed. However, the sonographer or radiologist is often able to review the ultrasound images in real-time as they are acquired and the patient can be released immediately.
This ultrasound examination is usually completed within 30 minutes.
What will I experience during and after the procedure?
Most ultrasound examinations are painless, fast and easy.
After you are positioned on the examination table, the radiologistor sonographer will apply some warm water-based gel on your skin and then place the transducer firmly against your body, moving it back and forth over the area of interest until the desired images are captured. There is usually no discomfort from pressure as the transducer is pressed against the area being examined.
If scanning is performed over an area of tenderness, you may feel pressure or minor pain from the transducer.
At times the sonographer may have to press more firmly to get closer to the embryo or fetus to visualize the structure better. Any discomfort is usually minimal and temporary.
If a Doppler ultrasound study is performed, you may actually hear pulse-like sounds that change in pitch as the blood flow is monitored and measured.
With transvaginal scanning, there may be minimal discomfort as the transducer is moved in the vagina.
Once the imaging is complete, the gel will be wiped off your skin.
After an ultrasound exam, you should be able to resume your normal activities immediately.
Who interprets the results and how do I get them?
A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care physician or the physician who referred you for the exam, who will share the results with you. In some cases the radiologist may discuss results with you at the conclusion of your examination.
What are the benefits vs. risks?
Benefits
- Most ultrasound scanning is noninvasive (no needles or injections) and is usually painless.
- Ultrasound is widely available, easy-to-use and less expensive than other imaging methods.
- Ultrasound imaging does not use any ionizing radiation.
- Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.
- Ultrasound is the preferred imaging modality for the diagnosis and monitoring of pregnant women and their unborn babies.
- Ultrasound has been used to evaluate pregnancy for nearly four decades and there has been no evidence of harm to the patient, embryo or fetus. Nevertheless, ultrasound should be performed only when medically indicated.
- Ultrasound allows the doctor to see inside the uterus and provides much information about the pregnancy.
Risks
- For standard diagnostic ultrasound there are no known harmful effects on humans.
What are the limitations of Obstetrical Ultrasound Imaging?
Obstetric ultrasound cannot identify all fetal abnormalities. Consequently, when there are clinical or laboratory suspicions for a possible abnormality, a pregnant woman may have to undergo nonradiologic testing such as amniocentesis (the evaluation of fluid taken from the sac surrounding the fetus) or chorionic villus sampling (evaluation of placental tissue) to determine the health of the fetus, or she may be referred by her primary care provider to a perinatologist (an obstetrician specializing in high-risk pregnancies).
Obstetric Ultrasound
Fetal face 3D ultrasound
Scrotal Ultrasound
- What is Ultrasound Imaging of the Scrotum?
- What are some common uses of the procedure?
- How should I prepare?
- What does the equipment look like?
- How does the procedure work?
- How is the procedure performed?
- What will I experience during and after the procedure?
- Who interprets the results and how do I get them?
- What are the benefits vs. risks?
- What are the limitations of Scrotal Ultrasound Imaging?
What is Ultrasound Imaging of the Scrotum?
Ultrasound imaging, also called ultrasound scanning or sonography, involves exposing part of the body to high-frequency sound waves to produce pictures of the inside of the body. Ultrasound exams do not use ionizing radiation (as used in x-rays). Because ultrasound images are captured in real-time, they can show the structure and movement of the body's internal organs, as well as blood flowing through blood vessels.
Ultrasound imaging is a noninvasive medical test that helps physicians diagnose and treat medical conditions.
Ultrasound imaging of the scrotum provides pictures of the testicles and the surrounding tissues of a man or a boy.
What are some common uses of the procedure?
Ultrasound imaging of the scrotum is the primary imaging method used to evaluate disorders of the testicles.
This study is typically used to:
- determine whether a mass in the scrotum felt by the patient or doctor is cystic or solid.
- diagnose results of trauma to the scrotal area.
- diagnose causes of testicular pain or swelling such as inflammation or torsion.
- evaluate the cause of infertility such as varicocele.
- look for the location of undescended testis.
Ultrasound is also a valuable tool for evaluating the epididymis (a tube that collects sperm made by the testicles) and the prostate.
A sudden onset of pain in the scrotum may be very serious. The most common cause of scrotal pain is epididymitis, an inflammation of the epididymis. It is treatable with antibiotics. If left untreated, this condition can lead to an abscess or loss of blood flow to the testicles.
Ultrasound can detect an absent or undescended testicle as well. In rare cases a testicle may fail to develop. More often, patients have an undescended testicle. It is estimated that approximately three percent of full-term baby boys have undescended testicles. It's important to diagnose an undescended testicle because it has a very high probability of developing cancer if left untreated.
Ultrasound can identify testicular torsion, the twisting of the spermatic cord that contains the vessels that supply blood to the scrotum. Caused by abnormally loose attachments of tissues that are formed during fetal development, torsion commonly appears during adolescence and is very painful. Torsion requires immediate surgery to avoid permanent damage to the testes.
Ultrasound also can be used to locate and evaluate palpable masses (lumps or tumors) in the scrotum. The majority of scrotal masses are located outside of the testes. Most masses found outside the testicles are benign or non-cancerous; most inside the testicles are malignant or cancerous. Collections of fluid and abnormalities of the blood vessels may appear as masses and can be assessed by ultrasound.
How should I prepare?
You should wear comfortable, loose-fitting clothing for your ultrasound exam. You may need to remove all clothing and jewelry in the area to be examined.
You may be asked to wear a gown during the procedure.
No other preparation is required.
What does the equipment look like?
Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer that is used to scan the body and blood vessels. The transducer is a small hand-held device that resembles a microphone, attached to the scanner by a cord. The transducer sends out high frequency sound waves into the body and then listens for the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and submarines.
The ultrasound image is immediately visible on a nearby video display screen that looks much like a computer or television monitor. The image is created based on the amplitude (strength), frequency and time it takes for the sound signal to return from the patient to the transducer and the type of body structure the sound travels through.
In order to perform a scrotal sonogram, most commonly a linear small parts transducer is used.
How does the procedure work?
Ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it bounces back, or echoes. By measuring these echo waves it is possible to determine how far away the object is and its size, shape, and consistency (whether the object is solid, filled with fluid, or both).
In medicine, ultrasound is used to detect changes in appearance of organs, tissues, and vessels or detect abnormal masses, such as tumors.
In an ultrasound examination, a transducer both sends the sound waves and records the echoing waves. When the transducer is pressed against the skin, it directs small pulses of inaudible, high-frequency sound waves into the body. As the sound waves bounce off of internal organs, fluids and tissues, the sensitive microphone in the transducer records tiny changes in the sound's pitch and direction. These signature waves are instantly measured and displayed by a computer, which in turn creates a real-time picture on the monitor. One or more frames of the moving pictures are typically captured as still images.
How is the procedure performed?
For most ultrasound exams, the patient is positioned lying face-up on an examination table that can be tilted or moved.
A clear water-based gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin. The sonographer (ultrasound technologist) or radiologist then presses the transducer firmly against the skin in various locations, sweeping over the area of interest or angling the sound beam from a farther location to better see an area of concern.
When the examination is complete, the patient may be asked to dress and wait while the ultrasound images are reviewed. However, the sonographer or radiologist is often able to review the ultrasound images in real-time as they are acquired and the patient can be released immediately.
This ultrasound examination is usually completed within 30 minutes.
What will I experience during and after the procedure?
Most ultrasound examinations are painless, fast and easy.
After you are positioned on the examination table, the radiologist or sonographer will apply some warm water-based gel on your skin and then place the transducer firmly against your body, moving it back and forth over the area of interest until the desired images are captured. There is usually no discomfort from pressure as the transducer is pressed against the area being examined.
If scanning is performed over an area of tenderness, you may feel pressure or minor pain from the transducer.
Once the imaging is complete, the gel will be wiped off your skin.
After an ultrasound exam, you should be able to resume your normal activities immediately.
Who interprets the results and how do I get them?
A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care physician or the physician who referred you for the exam, who will share the results with you. In some cases the radiologist may discuss results with you at the conclusion of your examination.
What are the benefits vs. risks?
Benefits
- Most ultrasound scanning is noninvasive (no needles or injections) and is usually painless.
- Ultrasound is widely available, easy-to-use and less expensive than other imaging methods.
- Ultrasound imaging does not use any ionizing radiation.
- Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.
- Ultrasound provides real-time imaging, making it a good tool for guiding minimally invasive procedures such as needle biopsies and needle aspiration.
Risks
- For standard diagnostic ultrasound there are no known harmful effects on humans.
What are the limitations of Scrotal Ultrasound Imaging?
Ultrasound of the scrotum does not always permit distinction between benign and malignant conditions.
Scrotal Ultrasound
Scrotal sonogram showing side view (longitudinal) of a testicle. Patient's head to left and feet to right out of the field of view.
varian Vein Embolization
- What is Ovarian Vein Embolization?
- How should I prepare?
- What does the equipment look like?
- How does the procedure work?
- How is the procedure performed?
- What will I experience during and after the procedure?
- Who interprets the results and how do I get them?
- What are the benefits vs. risks?
- What are the limitations of Ovarian Vein Embolization?
What is Ovarian Vein Embolization?
Ovarian vein embolization is a minimally invasive treatment for pelvic congestion syndrome that is used to close off faulty veins so they can no longer enlarge with blood, thus relieving the pain.
Pelvic congestion syndrome, also known as ovarian vein reflux, is a painful condition resulting from the presence of varicose veins in the pelvis. The condition is caused by valves in the veins that help return blood to the heart against gravity becoming weakened and not closing properly, allowing blood to flow backwards and pool in the vein causing pressure and bulging veins. Diagnosis of the condition is done through one of several methods: pelvic venography, magnetic resonance imaging and pelvic and transvaginal ultrasound.
During this procedure, an interventional radiologist inserts a catheter up the femoral vein and into the faulty vein(s). Catheterization requires only a small nick in the skin for insertion and x-ray image guidance of the catheter to its target area. The catheter delivers Dacron filaments-bearing coils that clot the blood and seal the faulty vein. The use of the recently developed Sotradecol foam agent allows the radiologist to block even the smallest veins not previously accessible.
How should I prepare?
You must stop taking aspirin and vitamin E at least five days before the procedure.
Have nothing to eat or drink after midnight prior to the procedure.
In general, you should not eat or drink for eight hours before your procedure. However, you may take your routine medications with sips of water. If you are diabetic and take insulin, you should talk to your doctor as your usual insulin dose may need to be adjusted.
Prior to your procedure, your blood may be tested to determine how well your liver and kidneys are functioning and whether your blood clots normally.
You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anesthetic medications,general anesthesia or to contrast materials (also known as "dye" or "x-ray dye"). Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or a blood thinner for a specified period of time before your procedure.
Also inform your doctor about recent illnesses or other medical conditions.
Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby. See the Safety page (www.RadiologyInfo.org/en/safety/) for more information about pregnancy and x-rays.
You will be admitted to the hospital on the morning of your procedure and be assessed by the interventional radiologist before the procedure begins.
You should wear comfortable, loose-fitting clothing to your exam. You may be given a gown to wear during the procedure.
What does the equipment look like?
In this procedure, x-ray equipment, a catheter and a variety of synthetic materials and medications, called embolic agents, are used.
The equipment typically used for this examination consists of a radiographic table, an x-ray tube and a television-like monitor that is located in the examining room or in a nearby room. When used for viewing images in real time (called fluoroscopy), the image intensifier (which converts x-rays into a video image) is suspended over a table on which the patient lies. When used for taking still pictures, the image is captured either electronically or on film.
A catheter is a long, thin plastic tube, about as thick as a strand of spaghetti.
Your physician will select an embolic agent depending on the size of the blood vessel or malformation and whether the treatment is intended to be permanent or temporary. These include:
- Gelfoam™, a gelatin sponge material, which is cut into small pieces that are injected into an artery and float downstream until they can go no further. After a period ranging from a few days to two weeks, the material dissolves. Gelfoam is used to control bleeding until the cause can be identified and fixed, or until it has time to heal on its own.
- particulate agents, including Polyvinyl alcohol (PVA) and gelatin-impregnated acrylic polymer spheres, which are suspended in liquid and injected into the bloodstream to block small vessels. These agents are used to block, or occlude, vessels permanently.
- various sized metal coils made of stainless steel or platinum are used to block large arteries.
- liquid sclerosing agents, which are used to destroy blood vessels and vessel malformations. Filling a vessel or a vessel malformation such as a fistula with this liquid agent causes blood clots to form, closing up the abnormal vascular channels.
- liquid glue, which can be inserted into a fistula or arteriovenous malformation (AVM) where it hardens, filling in this unnecessary passageway between artery and vein.
Other equipment that may be used during the procedure includes an intravenous line (IV) and equipment that monitors your heart beat and blood pressure.
How does the procedure work?
Using x-ray imaging and a contrast material to visualize the blood vessel, the interventional radiologist inserts a catheter through the skin into a blood vessel and advances it to the treatment site. A synthetic material or medication called an embolic agent is then inserted through the catheter and positioned within the blood vessel or malformation where it will remain either permanently or temporarily.
Temporary embolic agents block blood vessels long enough to allow the body to heal on its own. Permanent embolic agents physically plug-up blood vessels and cause scar tissue to form in the vessel. This is important in treating conditions such as arteriovenous malformations and tumors, which would recur if the embolic agent dissolved.
How is the procedure performed?
Image-guided, minimally invasive procedures such as embolization for pelvic congestion syndrome should be performed by a specially trained interventional radiologist in an interventional radiology suite or occasionally in the operating room.
Prior to your procedure, ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) may be performed.
You will be positioned on the examining table.
You will be connected to monitors that track your heart rate, blood pressure and pulse during the procedure.
A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm so that sedative medication can be given intravenously. You may also receive general anesthesia.
The area of your body where the catheter is to be inserted will be shaved, sterilized and covered with a surgical drape.
A very small nick is made in the skin at the site.
Using image-guidance, a catheter (a long, thin, hollow plastic tube) is inserted through the skin into a blood vessel and maneuvered to the treatment site.
A contrast material then is injected through your IV and a series of x-rays are taken to locate the exact site of bleeding or abnormality. The medication or embolic agent is then injected through the catheter. Additional angiograms are taken to ensure the embolic agent is correctly positioned and that any bleeding is controlled.
At the end of the procedure, the catheter will be removed and pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed.
Your intravenous line will be removed.
You can expect to stay in bed for six to eight hours after your procedure.
The length of the procedure varies from 30 minutes to several hours depending on the complexity of the condition.
What will I experience during and after the procedure?
Devices to monitor your heart rate and blood pressure will be attached to your body.
You will feel a slight pin prick when the needle is inserted into your vein for the intravenous line (IV) and when the local anesthetic is injected.
If the case is done with sedation, the intravenous (IV) sedative will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated.
You may feel slight pressure when the catheter is inserted but no serious discomfort.
As the contrast material passes through your body, you may get a warm feeling.
Most patients experience some side effects after embolization. Pain is the most common and can be controlled by medication given by mouth or through your IV.
Most patients leave the hospital within 24 hours of the procedure, but those who have considerable pain may have to stay longer.
You should be able to resume your normal activities within a week.
Who interprets the results and how do I get them?
The interventional radiologist can advise you as to whether the procedure was a technical success when it is completed.
In cases of bleeding, it may take 24 hours to know whether it has stopped. It may be one to three months after embolization before it is clear whether symptoms have been controlled or eliminated.
What are the benefits vs. risks?
Benefits
- Embolization is a highly effective way of controlling bleeding, especially in an emergency situation.
- Worldwide success rates of 85 percent and higher have been reported in women treated with embolization.
- Embolization is much less invasive than conventional open surgery. As a result, there are fewer complications and the hospital stay is relatively brief—often only the night after the procedure. Blood loss is less than with traditional surgical treatment, and there is no obvious surgical incision.
- This method can be used to treat tumors and vascular malformations that either cannot be removed surgically or would involve great risk if surgery was attempted.
- No surgical incision is needed—only a small nick in the skin that does not have to be stitched closed.
Risks
- There is a very slight risk of an allergic reaction if contrast material is injected.
- Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection.
- There is always a chance that an embolic agent can lodge in the wrong place and deprive normal tissue of its oxygen supply.
- There is a risk of infection after embolization, even if an antibiotic has been given.
What are the limitations of Ovarian Vein Embolization?
Successful embolization without injuring normal tissue requires that the catheter be placed in a precise position. This means that the catheter tip is situated so that embolic material can be deposited only in vessels serving the abnormal area. In a small percentage of cases, the procedure is not technically possible because the catheter cannot be positioned appropriately.
Uterine Fibroid Embolization (UFE)
- What is Uterine Fibroid Embolization (UFE)?
- What are some common uses of the procedure?
- How should I prepare for the procedure?
- What does the equipment look like?
- How does the procedure work?
- How is the procedure performed?
- What will I experience during and after the procedure?
- Who interprets the results and how do I get them?
- What are the benefits vs. risks?
- What are the limitations of Uterine Fibroid Embolization (UFE)?
What is Uterine Fibroid Embolization (UFE)?
Uterine fibroid embolization (UFE) is a minimally invasive treatment for fibroid tumorsof the uterus. The procedure is also sometimes referred to as Uterine Artery Embolization (UAE), but this term is less specific and, as will be discussed below, UAE is used for conditions other than fibroids.
Fibroid tumors, also known as myomas, are benign tumors that arise from the muscular wall of the uterus. It is extremely rare for them to turn cancerous. More commonly, they cause heavy menstrual bleeding, pain in the pelvic region, and pressure on the bladder or bowel.
In a UFE procedure, physicians use an x-ray camera called a fluoroscope to guide the delivery of small particles to the uterus and fibroids. The small particles are injected through a thin, flexible tube called a catheter. These block the arteries that provide blood flow, causing the fibroids to shrink. Nearly 90 percent of women with fibroids experience relief of their symptoms.
Because the effect of uterine fibroid embolization on fertility is not fully understood, UFE is typically offered to women who no longer wish to become pregnant or who want or need to avoid having a hysterectomy, which is the operation to remove the uterus.
What are other uses of the UAE procedure?
Uterine artery embolization has been used for decades to stop severe pelvic bleeding caused by:
- trauma
- malignant gynecological tumors
- hemorrhage after childbirth
Uterine fibroid embolization is a specialized form of UAE for treating symptomatic fibroids.
How should I prepare?
Imaging of the uterus by magnetic resonance imaging (MRI) or ultrasound is performed prior to the procedure to determine if fibroid tumors are the cause of your symptoms and to fully assess the size, number and location of the fibroids.
Occasionally, your gynecologist may want to take a direct look at the uterus by performing a laparoscopy. If you are bleeding heavily in between periods, a biopsy of the endometrium (the inner lining of the uterus) may be performed to rule out cancer.
You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anesthetic medications,general anesthesia or to contrast materials (also known as "dye" or "x-ray dye"). Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or a blood thinner for a specified period of time before your procedure.
Also inform your doctor about recent illnesses or other medical conditions.
Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby. See the Safety page (www.RadiologyInfo.org/en/safety/) for more information about pregnancy and x-rays.
You may be instructed not to eat or drink anything after midnight before your procedure. Your doctor will tell you which medications you may take in the morning.
You should plan to stay overnight at the hospital following your procedure.
You will be given a gown to wear during the procedure.
What does the equipment look like?
In this procedure, x-ray equipment, a catheter and a variety of medications and synthetic materials, called embolic agents, are used.
The equipment typically used for this examination consists of a radiographic table, an x-ray tube and a television-like monitor that is located in the examining room or in a nearby room. When used for viewing images in real time (called fluoroscopy), the image intensifier (which converts x-rays into a video image) is suspended over a table on which the patient lies. When used for taking still pictures, the image is captured either electronically or on film.
A catheter is a long, thin plastic tube, about as thick as a strand of spaghetti.
Several different types of embolic agents are used for uterine fibroid embolization. They act similarly, but differ in their composition:
- polyvinyl alcohol, a plastic material resembling coarse sand
- Gelfoam™, a gelatin sponge material
- microspheres, polyacrylamide spheres with a gelatin coating
All of these have been shown to be safe and effective for uterine fibroid embolization.
Other equipment that may be used during the procedure includes an intravenous line (IV) and equipment that monitors your heart beat and blood pressure.
How does the procedure work?
The procedure involves inserting a catheter through the groin, maneuvering it through the uterine artery, and injecting the embolic agent into the arteries that supply blood to the uterus and fibroids. As the fibroids die and begin to shrink, the uterus fully recovers.
How is the procedure performed?
UFE is an image-guided, minimally invasive procedure that uses a high-definition x-ray camera to guide a trained specialist, most commonly an interventional radiologist to introduce a catheter into the uterine arteries to deliver the particles. The procedure is typically performed in a cath lab or occasionally in the operating room.
You will be positioned on the examining table.
You will be connected to monitors that track your heart rate, blood pressure and pulse during the procedure.
A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm so that sedative medication can be given intravenously. You may also receive general anesthesia.
The area of your body where the catheter is to be inserted will be shaved, sterilized and covered with a surgical drape.
Your physician will numb the area with a local anesthetic.
A very small nick is made in the skin at the site.
Using x-ray guidance, a catheter is inserted into your femoral artery, which is located in the groin area. A contrast material provides a roadmap for the catheter as it is maneuvered into your uterine arteries. The embolic agent is released into both the right and left uterine arteries by repositioning the same catheter that was originally inserted. Only one small skin puncture is required for the entire procedure.
At the end of the procedure, the catheter will be removed and pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed.
Your intravenous line will be removed.
You will most likely remain in the hospital overnight so that you may receive pain medications and be observed.
This procedure is usually completed within 90 minutes.
What will I experience during and after the procedure?
Devices to monitor your heart rate and blood pressure will be attached to your body.
You will feel a slight pin prick when the needle is inserted into your vein for the intravenous line (IV) and when the local anesthetic is injected.
If the case is done with sedation, the intravenous (IV) sedative will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated.
You may feel slight pressure when the catheter is inserted but no serious discomfort.
As the contrast material passes through your body, you may get a warm feeling.
While you are in the hospital, your pain will be well-controlled with a narcotic.
After staying overnight at the hospital, you should be able to return home the day after the procedure.
You may experience pelvic cramps for several days after your UFE, and possibly mild nausea and low-grade fever as well. The cramps are most severe during the first 24 hours after the procedure and will improve rapidly over the next several days. While in the hospital, the discomfort usually is well-controlled with pain medication delivered through your IV.
Once you return home, you will be given prescriptions for pain and other medications to be taken by mouth. You should be able to return to your normal activities within one to two weeks after UFE.
Afterward, it is common for menstrual bleeding to be much less during the first cycle and gradually increase to a new level that is usually greatly improved as compared to before the procedure. Occasionally you may miss a cycle or two or even rarely stop having periods altogether. Relief of bulk-related symptoms usually takes two to three weeks to be noticeable and over a period of months the fibroids to continue to shrink and soften. By six months, the process has usually finished and the amount of symptom improvement will stabilize.
Who interprets the results and how do I get them?
The interventional radiologist will discuss the results with you and coordinate follow-up care with your primary care physician or gynecologist.
What are the benefits vs. risks?
Benefits
- Uterine fibroid embolization, done under local anesthesia, is much less invasive than open surgery done to remove uterine fibroids or the whole uterus (hysterectomy).
- No surgical incision is needed—only a small nick in the skin that does not have to be stitched closed.
- Patients ordinarily can resume their usual activities weeks earlier than if they had a hysterectomy.
- Blood loss during uterine fibroid embolization is minimal, the recovery time is much shorter than for hysterectomy, and general anesthesia is not required.
- Follow-up studies have shown that nearly 90 percent of women who have their fibroids treated by uterine fibroid embolization experience either significant or complete resolution of their fibroid-related symptoms. This is true for women with heavy bleeding and for those with bulk-related symptoms such as pelvic pain or pressure. On average, fibroids will shrink to half their original volume, which amounts to about a 20% reduction in their diameter.
- Follow-up studies over several years have shown that it is rare for treated fibroids to regrow or for new fibroids to develop after uterine fibroid embolization. This is because all fibroids present in the uterus, even early-stage masses that may be too small to see on imaging studies, are treated during the procedure. Uterine fibroid embolization is a more permanent solution than another option, hormone therapy, because when hormonal treatment is stopped the fibroid tumors usually grow back. Regrowth also has been a problem with laser treatment of uterine fibroids.
Risks
- Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection.
- When performed by an experienced interventional radiologist, the chance of any of these events occurring during uterine fibroid embolization is less than one percent.
- Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
- There is always a chance that an embolic agent can lodge in the wrong place and deprive normal tissue of its oxygen supply.
- An occasional patient may have an allergic reaction to the x-ray contrast material used during uterine fibroid embolization. These episodes range from mild itching to severe reactions that can affect a woman's breathing or blood pressure. Women undergoing UFE are carefully monitored by a physician and a nurse during the procedure, so that any allergic reaction can be detected immediately and addressed.
- Approximately two to three percent of women will pass small pieces of fibroid tissue after uterine fibroid embolization. This occurs when fibroid tissue located near the lining of the uterus dies and partially detaches. Women with this problem may require a procedure called D & C (dilatation and curettage) to be certain that all the material is removed so that bleeding and infection will not develop.
- In the majority of women undergoing uterine fibroid embolization, normal menstrual cycles resume after the procedure. However, in approximately one percent to five percent of women, menopause occurs after uterine fibroid embolization. This appears to occur more commonly in women who are older than 45 years.
- Although the goal of uterine fibroid embolization is to cure fibroid-related symptoms without surgery, some women may eventually need to have a hysterectomy because of infection or persistent symptoms. The likelihood of requiring hysterectomy after uterine fibroid embolization is low—less than one percent.
- Women are exposed to x-rays during uterine fibroid embolization, but exposure levels usually are well below those where adverse effects on the patient or future childbearing would be a concern.
- The question of whether uterine fibroid embolization impacts fertility has not yet been answered, although a number of healthy pregnancies have been documented in women who have had the procedure. Because of this uncertainty, physicians may recommend that a woman who wishes to have more children consider surgical removal of the individual tumors rather than uterine fibroid embolization. If this is not possible, then UFE may still be the best option.
- It is not possible to predict whether the uterine wall is in any way weakened by UFE, which might pose a problem during delivery. Therefore, the current recommendation is to use contraception for six months after the procedure and to undergo a Cesarean section during delivery rather than to risk rupturing the wall of the uterus during the contractions of labor.
What are the limitations of Uterine Fibroid Embolization (UFE)?
Uterine fibroid embolization should not be performed in women who have no symptoms from their fibroid tumors, when cancer is a possibility, or when there is inflammation or infection in the pelvis. Uterine fibroid embolization also should be avoided in women who are pregnant or in women whose kidneys are not working properly—a condition known as renal insufficiency. A woman who is very allergic to contrast material (which contains iodine) should be offered a different treatment option.
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