Uterine Artery Embolization (UAE) — Dictation, Appropriateness, and Dose for Residents

1. The Consult: Symptomatic Fibroids, Patient Wants to Avoid Surgery

The consult comes in from Gynecology. A 42-year-old patient with debilitating menorrhagia and bulk symptoms from uterine fibroids. She’s failed medical management and is adamant about avoiding a hysterectomy. She’s a perfect candidate for Uterine Artery Embolization (UAE). Your attending expects a procedure note that’s not just a narrative, but a structured report covering access, selective catheterization, embolic choice, and the final angiographic endpoint. This isn’t just about doing the procedure; it’s about documenting it with precision.

When I was a fellow, the challenge wasn’t just getting the microcatheter into the uterine artery; it was remembering every key detail for the report while managing the patient’s post-procedure pain. Forgetting to document the embolic size or the final angiographic result is a rookie mistake. Let’s make sure your reports are airtight from day one. For more high-yield guides like this, check out the residents and fellows resource hub we’ve put together.

2. What a Uterine Artery Embolization (UAE) Report Covers and What Attendings Look For

A Uterine Artery Embolization is a minimally invasive procedure designed to block the blood supply to uterine fibroids, causing them to shrink and symptoms to resolve. It’s a mainstay of IR, but the report needs to be more than just “embolization performed.” Your attending is looking for a clear, logical progression that justifies the procedure and documents its technical success and safety.

A robust UAE procedure note will always include:

• Pre-procedure Assessment: Confirmation of indication (symptomatic fibroids) and a brief summary of pre-procedure MRI findings (number, size, location of fibroids).
• Vascular Access: The access site (typically right common femoral artery) and sheath size.
• Catheterization Details: Documentation of selective catheterization of the bilateral internal iliac and, subsequently, uterine arteries. Mention the catheters and microcatheters used.
• Angiographic Findings: A description of the pre-embolization angiogram, confirming hypervascularity of the fibroids and identifying any significant ovarian artery contributions.
• Embolization Details: The type and size of embolic agent used (e.g., 300-500 µm or 500-700 µm microspheres) and the endpoint achieved (e.g., stasis of flow). This must be documented for both uterine arteries.
• Completion and Hemostasis: Final angiographic run, sheath removal, and method of hemostasis.
• Fluoro Time and Dose: Total fluoroscopy time and dose area product (DAP) or effective dose.

3. Radiology Report Template for Uterine Artery Embolization (UAE)

This template provides a solid foundation. You can use this as a macro in your dictation software. The key is to be systematic, covering every critical step of the procedure for both sides.

Technique

After obtaining informed consent, the patient was brought to the interventional radiology suite and placed in the supine position. The [right/left] common femoral artery was accessed using micropuncture technique under ultrasound guidance. A [5]-French sheath was placed.

A [5]-French [catheter type, e.g., Simmons 1, C2] catheter was advanced into the contralateral internal iliac artery. A coaxial microcatheter was used to selectively catheterize the [left] uterine artery. A pre-embolization angiogram was performed. Embolization was then performed using [embolic agent and size, e.g., 500-700 µm microspheres] until stasis of flow was achieved in the distal uterine artery branches.

The same procedure was repeated on the [right] side. The catheter was used to select the ipsilateral internal iliac artery, and the [right] uterine artery was selectively catheterized. Pre-embolization angiography was performed, followed by embolization with [embolic agent and size] to stasis.

A final pelvic aortogram demonstrated successful embolization of both uterine arteries with no evidence of non-target embolization. The catheter and sheath were removed, and hemostasis was achieved with a vascular closure device / manual pressure.

Findings

Pre-Embolization Angiography: Digital subtraction angiography of the bilateral uterine arteries demonstrated enlarged, tortuous uterine arteries supplying multiple hypervascular uterine fibroids, consistent with the pre-procedure MRI. [If applicable: A significant contribution from an ovarian artery was noted on the left/right/bilaterally.]

Post-Embolization Angiography: Post-embolization runs in both uterine arteries demonstrated successful stasis of flow to the fibroid bed. The main uterine arteries remained patent proximally. There was no evidence of non-target embolization to the ovaries, bladder, or rectum.

Fluoroscopy Time: [XX.X] minutes.
Contrast Volume: [XX] mL of [contrast agent].
Radiation Dose: [XX] mGy or DAP.

Impression

Successful superselective bilateral uterine artery embolization for the treatment of symptomatic uterine fibroids.

Resident Dictation Checklist:

• Bilateral Embolization: Did you document embolizing both uterine arteries? This is non-negotiable, as unilateral treatment allows for collateral resupply.
• Embolic Size: Did you state the microsphere size (e.g., 300-500 µm or 500-700 µm)? This is critical; smaller particles carry a higher risk of non-target embolization to the ovaries.
• Endpoint: Did you describe the angiographic endpoint? “Stasis” or “near-stasis” is the standard.
• Pain Management: While not in the report, confirm the plan is in place. Severe ischemic pain is expected in the first 6-24 hours.
• Fertility: Remember that UAE may reduce ovarian reserve. Myomectomy is generally preferred for patients actively planning pregnancy.
• PPH Variant: If doing this for postpartum hemorrhage, you’re likely using temporary agents like Gelfoam, not permanent microspheres. Document this clearly.

4. Free Template Sources for Your On-Call Toolkit

Building your own template library is a rite of passage. But before you reinvent the wheel, it’s worth knowing that two great free repositories exist for community-sourced templates. They are excellent starting points for creating your own macros.

• RadReport.org: Curated by the RSNA, this is a comprehensive library of peer-reviewed templates covering nearly every modality and subspecialty.
• Radiology Templates (AU): An Australian-maintained resource with a clean interface and practical, clinically-focused templates that are easy to adapt.

Use these to see how others structure complex reports, then customize them for your institution’s specific needs and your attendings’ preferences.

5. The Next-Level Move: Free-Form Dictation to Structured Report

The real bottleneck on call isn’t just finding a template; it’s populating it accurately under pressure. Instead of clicking through fields or copy-pasting, you can dictate the key findings naturally. For example: “Right common femoral access, selected the left uterine artery with a microcatheter, pre-embolization angio shows hypervascular fibroids. Embolized to stasis with 500-700 micron spheres. Repeated on the right, same findings, same result.”

This is where AI-powered tools can streamline your workflow. GigHz Precision AI is designed to take that kind of free-form dictation and generate a complete, structured report. It automatically populates the appropriate sections of a pre-loaded SIR or ACR template, ensuring you don’t miss key elements like laterality, embolic size, or the angiographic endpoint. It also handles the automated firing of any relevant Clinical Decision Support (CDS) frameworks, though none are specific to this particular procedure template. The goal is to let you focus on the clinical narrative while the AI handles the formatting, helping you create attending-level reports faster.

6. When Should You Recommend a Uterine Artery Embolization? ACR Appropriateness Criteria

The decision to proceed with UAE is often made in consultation with OB/GYN, but as the interventionalist, you need to know the evidence. The American College of Radiology (ACR) provides clear guidance on managing uterine fibroids.

For a reproductive-age patient with symptomatic fibroids (heavy bleeding or bulk symptoms), UAE is rated as Usually Appropriate (8/9), regardless of whether she desires to preserve fertility or not. It stands as a primary alternative to surgical options like myomectomy or hysterectomy. However, for patients who are actively trying to become pregnant, myomectomy is often preferred as UAE may impact ovarian reserve and fertility.

The criteria also address more complex scenarios. For patients with concurrent adenomyosis or those with pedunculated submucosal fibroids, UAE remains Usually Appropriate (8/9). Similarly, for postmenopausal patients with symptomatic fibroids and a negative endometrial biopsy, UAE is also considered Usually Appropriate (8/9) as a next step in management. These guidelines confirm UAE’s role as a versatile, first-line, minimally invasive therapy for a wide range of patients with symptomatic fibroids.

7. How Much Radiation Does a Uterine Artery Embolization Deliver?

Patients are increasingly aware of radiation dose, and you should be prepared to discuss it. A Uterine Artery Embolization is a fluoroscopically-guided procedure and involves a moderate radiation dose.

The estimated effective dose for a UAE is typically in the range of 10-30 mSv. To put this in perspective, this is equivalent to several years of natural background radiation. While this is not insignificant, the dose is justified by the significant clinical benefit of treating debilitating symptoms with a minimally invasive approach that avoids major surgery. Dose is always managed according to ALARA (As Low As Reasonably Achievable) principles, using techniques like low-frame-rate fluoroscopy, collimation, and minimizing magnification to keep the exposure as low as possible while ensuring procedural success.

8. Uterine Artery Embolization (UAE) Protocol — Phases, Contrast, and Key Steps

A successful UAE relies on a standardized, systematic approach. The protocol involves careful pre-procedural planning with MRI, followed by precise angiographic technique. The key is methodical, bilateral embolization to ensure the entire fibroid burden is treated.

The procedure uses iodinated contrast to visualize the pelvic vasculature. Typically, 50-100 mL of a non-ionic agent (e.g., Iohexol 350) is sufficient for the entire case. The most common pitfall is failing to achieve complete stasis bilaterally, which can lead to treatment failure from collateral blood supply.

9. The 3-Months-Free Offer for Radiology Residents and Fellows

Look like a rockstar on your reports. We’re offering 3+ months of free access to GigHz Precision AI for all radiology residents and fellows. You can dictate your positive findings in free form, and the AI will generate a complete, structured report using the latest ACR and SIR templates. It helps ensure your reports are clean, comprehensive, and have all the key elements your attendings are looking for.

All we ask in return is your feedback so we can keep improving the product for trainees. The signup process is simple—no credit card, no long forms. To get started, just provide these three items:

1. Your PGY year (e.g., PGY-2, PGY-4)
2. Your training type (radiology residency or fellowship specialty)
3. Your training program or hospital name

Ready to give it a try? Apply for the residents free-access program and we’ll get you set up.

10. Frequently Asked Questions (FAQ)

Is GigHz Precision AI HIPAA-compliant?

Yes. The platform is designed for de-identified workflows by default. It processes the clinical content of your dictation without requiring or storing patient health information (PHI). All processing occurs over secure, encrypted connections.

Do I need my hospital’s IT department to set this up?

No. GigHz Precision AI is browser-based and requires no local software installation or special permissions. It works on any modern web browser, including the ones on hospital workstations or your personal laptop or iPad.

Does this replace PowerScribe or other dictation software?

No, it works alongside it. You can dictate into the GigHz web interface, and the structured report it generates can be easily copied and pasted into your PACS/RIS/EMR system as the final report text. It complements your existing workflow, rather than replacing it.

Can I use this on my phone or iPad on call?

Yes. The platform is fully responsive and designed to work on mobile devices, making it easy to use in call rooms, reading rooms, or on the go.

Can I customize the templates?

Yes. While the system comes pre-loaded with standard ACR and society-level templates, you can create, modify, and save your own custom templates to match your personal preferences or your institution’s specific requirements.

What happens after my residency or fellowship ends?

The free access program is specifically for trainees. After you graduate, you can choose to transition to a paid plan for practicing radiologists. We offer discounts for recent graduates to help you get started in your new role.