procedure. The first follow-up visit is to look for post procedure complications, and the subsequent ones to check on symptom benefit and late complications.
The recent recognition of interventional radiology as an official sub-specialty by the postgraduate medical education and training board (PMETB) further contributes to the process of development of the clinical interventional radiologist.
Research There are still a number of questions in the management of symptomatic fibroids and, more specifically, within interventional radiology: • How does UAE compare to myomectomy in the same patient group? This is a key question because both techniques are uterus sparing. An RCT from Mara et al10 randomised patients to either UAE or myomectomy, and they have reported mid term results. Their numbers, however, are small and this is still an unanswered question.
• Is there an ideal embolic agent? • Is there an ideal particle size? • Is it possible to predict fibroid shrinkage on pre-procedure imaging? • Is there a sub-clinical effect of UAE on fertility?
The long-term follow-up data from the clinical trials, as mentioned before, are outstanding. Research is crucial in the continued development of the technique and for answering these important questions. Equally, other minimally invasive alternatives such as magnetic resonance guided focussed ultrasound treatment 20 guided laser ablation21
are under development and are showing promising results.
Training The ready availability of local expertise in UAE is variable across the United Kingdom and this is an important factor from both the patient’s and the referrer’s perspective. The local UAE service should also be staffed with skilled and competent personnel. Training of interventional radiologists in the procedure is another key factor. The training should not be restricted to technical competence, but also include patient assessment, both clinical and radiological, as well as follow-up.
Guidance on appropriate training in the various aspects of UAE features both in the Royal College of Radiologists` new curriculum22
and the Interventional Radiology syllabus23 , as
recommended by the Cardiovascular and Interventional Radiological Society of Europe (CIRSE). These measures help standardise training, thus helping to ensure delivery of a quality service.
Education Educating patients, clinicians and even the general public will help significantly in developing a greater understanding of the procedure, thus enhancing its profile and generating greater public acceptance. Patients need to consider UEA as a safe and efficient treatment procedure for fibroids.
the benefits of uae are irrefutable
The clinicians - both primary care and secondary referrers - need working knowledge of the indications, the current literature, the practicalities involved for the patient, and the potential complications. This process should also include non interventional radiologists who are sometimes consulted regarding treatment of fibroids.
Uterine artery embolisation is perceived by the general public as an experimental procedure restricted to a few specialised centres. During consultations, patients often enquire if the procedure is experimental. Any misconceptions must be overcome and education is the key. A robust patient information leaflet is essential and should be disseminated to general practices and other appropriate public areas. The internet is another powerful tool in educating the public, but it can equally be a deterrent with some websites giving wrong or inaccurate information. Arguably, another effective method of information dissemination is the patient herself. A good overall experience with good symptom benefit can result in a ‘word of mouth’ type education for the wider public. Any way of enhancing profile is good for the procedure.
and magnetic resonance
CONCLUSION Uterine artery embolisation should be considered in patients with symptomatic fibroids who desire to retain their uterus, irrespective of their age. Continued research and technological developments will ensure the procedure evolves and gains more widespread acceptance and popularity. In terms of patient welfare and cost effectiveness in today’s patient-focused healthcare environment, the benefits of UAE are irrefutable, and it is no longer acceptable to perform hysterectomies because of a lack of local expertise and/or ignorance.
61 2011
IMAGING & ONCOLOGY
Dr Ram Kasthuri is a consultant interventional radiologist and honorary clinical senior lecturer at Gartnavel General Hospital, Glasgow. Professor Jon Moss is a consultant interventional radiologist and professor of radiology at the same institution.
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