Uterine embolization has become a commonly used procedure for the treatment for uterine leiomyomata and previously published studies have suggested that the procedure is effective in controlling symptoms.1–3 The procedure has become widely used in a variety of practice settings, but the success of the procedure in that broader context has not been known.
The Fibroid Registry for Outcomes Data (FIBROID) was established in 1999 and began enrolling patients in 2000, with more than 3,000 patients entered before the closure of enrollment in December 2002. Its purpose was to determine the short- and long-term outcomes from uterine artery embolization for leiomyomata, including adverse events, symptom and quality-of-life change, additional interventions, and patient satisfaction, as well as analysis of potential predictors of those outcomes during follow-up. The initial baseline demographics have recently been reported,4 as have the short-term outcomes, including adverse events.5 The study is ongoing and the patient cohort will be followed up for a total of 3 years. We present here the outcomes reported at 6 and 12 months after treatment.
MATERIALS AND METHODS
The FIBROID Registry was developed in 1999 by the Cardiovascular and Interventional Radiology Research and Education Foundation (now the Society of Interventional Radiology Foundation), in collaboration with the Duke Clinical Research Institute, to estimate the safety and effectiveness of this procedure. The Registry was designed as a prospective multicenter voluntary effort to evaluate the short- and long-term outcome of uterine artery embolization in practice throughout the United States. Members of the Society of Interventional Radiology were canvassed for interest in participating in the Registry.
Two levels of participation in the registry were defined, core sites and participating sites. Core sites were those with prior uterine embolization experience of at least 24 cases and an anticipated monthly volume of at least 5 cases. The intent was to have this group rapidly enroll a large number of patients. The core sites were required to have a study coordinator and were required to gather extensive baseline data. The resources required for participation in long-term follow-up (site study coordinator) were beyond the means of many physicians interested in participation in the registry and thus participating sites were also created. Any member of the Society of Interventional Radiology was allowed to enroll as an investigator at a participating site. These sites enrolled patients for the short-term follow-up phase of the study only and thus the patients treated in these sites were not included in follow-up beyond 30 days after the procedure. The 2 types of sites were created to accommodate a larger number of physicians and a broader range of practice types for the short-term portion of the study that focused on adverse events, while ensuring a set of patients from core sites with sufficient data for long-term outcome assessment.
Participation in the Registry was voluntary for both core and participating sites, and there was no financial support for the sites. Each site had the protocol approved by its institutional review board. Written informed consent for the collection of short-term data was obtained from each enrolled patient, and additional consent was obtained for those core site patients agreeing to long-term follow-up.
The baseline data and follow-up data to 30 days after the procedure, including adverse events, were collected by the site investigator and coordinator. The baseline data included demographics, reproductive history, comorbidities, and imaging findings of the uterus and leiomyomata. These results were presented in an earlier publication.4 The procedure-related data and complications up to 30 days after the procedure are reported in the same journal issue.5
The data management center, the Duke Clinical Research Institute, obtained all the follow-up for longer-term outcome that is the basis for this report. The investigators did not have input or direct contact with the patients for this portion of the data collection. At each follow-up interval (in this case the 6 and 12 month marks) the patient was sent a packet that included the Uterine Fibroid Symptom and Quality of Life questionnaire and an additional set of questions regarding outcome. These items included questions regarding presence of menstrual periods, current medications or interventions for leiomyoma-related symptoms, new unwanted changes in sexual function, and emergency room visits or rehospitalization for leiomyoma-related problems. As a measure of patient satisfaction, participants were also asked to state the degree to which they would recommend the procedure to their family members or friends, responding on a scale from strongly disagree to strongly agree. Finally, there were questions about subsequent pregnancy, complications of pregnancy, and pregnancy outcomes. The pregnancy data continue to be gathered and will be reported in a later publication.
The primary measures of outcome are the symptom and health-related quality-of-life scores from the Uterine Fibroid Symptom and Quality of Life questionnaire. The scores from the questionnaire range from 0 to 100; higher scores on the health-related quality-of-life scale indicate a better score, while a lower score is better on the symptom scale, indicating fewer symptoms.
At the 6-month follow-up interval, eligibility was determined by the patient meeting each the following criteria: the patient must have been enrolled at a core site, had indicated at enrollment a willingness to complete follow-up, had complete baseline symptom and quality-of-life score from the Uterine Fibroid Symptom and Quality of Life and baseline data set, and had provided a complete mailing address or telephone number at baseline. At each subsequent follow-up interval (in the case of this report, the 12-month follow-up), the above criteria still applied, regardless of whether a response was obtained for the preceding interval. Only those who had had a hysterectomy before the preceding follow-up or who requested to withdraw at that interval follow-up were excluded from further follow-up efforts. The follow-up questionnaire packets were initially mailed to the patients. If there was no response, the patient was telephoned by a trained interviewer and offered to complete the questionnaires by phone. The details of this process have been described in an earlier publication.4
Between December 13, 2000, and December 31, 2002, 3,319 uterine artery embolization cases were logged into the Registry. Of these, 2,112 were eligible for long-term follow-up patients. The balance of the patients did not qualify for long-term follow-up. Of the 2,112 patients eligible, 1,797 (85.1%) provided 6-month follow-up and 1,701 (80.5%) provided 12-month data, and this cohort formed the population from which the 6- and 12-month analysis was completed. Because there was a large proportion of patients not eligible or unwilling to participate in follow-up, Wilcoxon 2-sample and χ2 tests were used to compare those eligible for follow-up at 12 months to those not eligible for long-term follow-up to determine whether there were differences in the baseline characteristics in these groups. A similar analysis was completed for those who were eligible for follow-up, comparing those who completed follow-up with those who did not.
Data analysis included summary statistics, using proportions and confidence intervals for categorical variables and means, standard deviations, medians, and quartiles for continuous variables. The factors offered to the model to assess effect on outcome included baseline factors (age, race, body mass index, parity, any comorbidities, smoking behavior, prior medical or procedural therapy for leiomyomata, predominant presenting symptoms [heavy bleeding, pain, bulk symptoms, or other], uterine volume, leiomyoma location within the uterus [fundal, anterior body, posterior body, lateral body, cervical], size, morphology (submucosal, intramural, or serosal], and number of leiomyomata) and postprocedure factors (embolic material, deep vein thrombosis prophylactic use, prophylactic antibiotic use, length of procedure, and vessel embolized). Bulk symptoms were defined as sensations of pelvic pressure or heaviness or urinary pressure. “Other” symptoms were any primary symptom other than heavy bleeding, pain, or bulk symptoms.
We evaluated effects of baseline patient characteristics on score (Uterine Fibroid Symptom and Quality of Life and health-related quality-of-life) using 2 methods: initially, we used delta score as the response variable, where delta was the difference in scores between the follow-up time point and the baseline time point. For this analysis, only patients with relevant scores available for both time points were used. The delta score outcome was analyzed using a linear mixed model with site as a random effect and all patient-related covariates as fixed effects.
Because this model does not adequately capture each patient’s score trajectory over time, we analyzed scores using a repeated-measures method that makes use of all available data. This more comprehensive method assessed changes in scores over time and the factors associated with change. Each patient could then have a minimum of 1 score (baseline score) and a maximum of 3 scores (baseline, 6 months, and 12 months). Because, for a single patient, the score at any time point is correlated with scores at the other time points, it is important to take into consideration this within-patient correlation between responses. For this analysis, a linear mixed model with unstructured covariance matrix was used to model the outcome. All factors that could potentially affect the outcome were first included in the model, including a dichotomous indicator for each time period (6 months and 12 months) and interaction effects between covariates and time, to allow the possibility that the effect of factors on the outcome could change over time. Factors that came into play only after the procedure and would not affect baseline symptom score were included only as interaction effects with time. In both methods of analysis, variables that were not significant in the full model were eliminated sequentially starting with the interaction effects.
The final model in the second analysis consisted of effects that were significant at any time point such that 1) a factor that has an effect only at a later time point would be included with all preceding time points and 2) a factor that has an effect at an earlier time point would be included only at that and all preceding time points. Because of space limitations, only the results of symptom scores from this second method of analysis are presented. The significance of variables was assessed at the .05 alpha level. All analyses were conducted using SAS 8.2 (SAS Institute Inc., Cary, NC).
The comparison of patients who completed follow-up at 12 months to those entered in the registry that were not eligible to participate in follow-up showed no difference in age, prior interventions or medical therapies, smoking status, and uterine anatomy. There were some differences. In the follow-up group, there was a larger proportion of whites (47.42% compared with 44.36%, P = .027), lower body mass index (27.65 compared with 28.28, P = .001), fewer medical comorbidities (68.64 compared with 72.10, P = .045), and a greater proportion of patients presenting with a primary complaint of bulk symptoms (25.82% compared with 19.26%, P < .001).
Among the 2,112 patients eligible for the follow-up phase of the study, those who completed 12-month follow-up were compared with those who did not. Those not completing follow-up were more likely to be African American (53.3% compared with 48%, P < .001), had a greater mean body mass index (28.6 compared with 27.6, P = .002), were more likely smokers (36.8% compared with 31.8%, P = .05), more likely to have a predominant symptom of heavy bleeding before treatment (65.6% compared with 63.2%, P = .01), and were more likely to have had an adverse event (22.8 % compared with 22.4%, P = .02). There were no differences in patient age, prior medical, surgical, or reproductive history, comorbidities, or leiomyoma or uterine anatomy between these 2 groups.
Table 1 presents the results of the Uterine Fibroid Symptom and Quality of Life questionnaire at 6 and 12 months after uterine artery embolization. At baseline, the mean symptom score (± standard deviation) was 58.61 (± 20.82). The mean symptom score at 6 months was 19.87 (± 18.61), and the median was 15.63 (interquartile range [IQR] 6.25–28.13). At 12 months, very similar scores were noted, with the mean at 19.23 (± 17.94) and the median at 15.63 (IQR 6.25–28.13). When compared with baseline, the symptom score improved by a mean of 38.62 points (standard error [SE] 0.60, P < .001) at 6 months and by a mean of 38.94 points (SE 0.52, P < .001) at 12 months. There was no difference in symptom scores between 6 and 12 months (P = .177).
For the health-related quality-of-life total score, the baseline mean score was 46.95 (± 23.03), with a median of 47 (IQR 29–65). By 6 months, the mean score increased to 85.04 (± 20.06) with a median 93.95 (IQR (79.30–99.13). At 12 months, health-related quality-of-life mean score was 86.68 (± 18.15) and the median was 93.95 (IQR 81.89–100). The mean score change was 37.69 (SE 0.58) at 6 months and 39.67 (SE 0.55) at 12 months, both significant changes (P < .001). There was continued improvement between 6 and 12 months in mean health-related quality-of-life scores (+1.98, SE 0.40, P < .001).
Fewer than 7% of patients failed to have an improved symptom score at 6 months and fewer than 6% failed to improve their score at 12 months. There was greater than a 10-point improvement in symptom score in 85.5% of patients at 6 months and 86.8% at 12 months.
The frequency of additional medical or surgical therapy or unplanned emergency room or hospital care for leiomyoma symptoms is summarized in Table 2. At the time of the 6-month follow-up, 7.0% of patients were using hormonal or other medical therapy for leiomyoma-related symptoms; whether this represented continuation of preprocedure therapy or institution of new therapies was not recorded. This number was 7.1% at the 12-month follow-up. The duration of the medical care was not recorded. Overall, 3.6% of patients required 1 or more subsequent gynecologic interventions by 6 months and an additional 5.9% needed interventions by 12 months. Among these, the most common intervention was hysterectomy, a total of 49 in the interval from baseline to 12 months, 2.9% of total patients completing follow-up at 12 months. An additional 25 (1.45%) patients had myomectomy and 21 (1.21%) had repeat uterine artery embolization during the first year of follow-up. The balance of these procedures were minimally-invasive gynecologic procedures, as presented in Table 2. The indications for the interventions were not recorded in the registry. Emergency room visits were needed in 68 (3.78%) patients by 6 months and an additional 20 patients (1.18%) by 12 months. Unexpected hospitalization occurred in 52 (2.89%) at 6 months and in an additional 37 (2.18%) at 12 months.
Changes in menstrual cyclicity are the main measure of potential effects of uterine artery embolization on ovarian function in the registry. Of the patients completing 12-month follow-up, 125 or 7.3% had onset of amenorrhea after uterine artery embolization; of these, 3 (2.01%) were aged 35–39 years, 15 (12.0 %) were aged 40–44 years, 53 (42.40%) were aged 45–50 years, and 54 (43.20%) were older than age 50 years. However, whether these patients had cycles for some time after the procedure and then stopped or the procedure precipitated amenorrhea is not known.
Patient satisfaction was assessed by asking at each follow-up interval whether the patient would recommend the uterine artery embolization procedure to her family members or friends. In response to this question, 84.26% agreed or strongly agreed at 6 months and 82% agreed or strongly agreed at 12 months.
The analysis of potential predictors of a greater improvement in symptom and health-related quality-of-life scores 12 months after embolization suggested several factors that might influence outcome and are presented in Table 3. The predominant presenting symptom influenced the change in symptom and health-related quality-of-life scores—those with heavy menstrual bleeding had the greatest change in scores afterward. Leiomyoma size also affected the degree to which the symptom score improved. For each centimeter increase in the largest leiomyoma diameter, the 12-month symptom score change decreased on average 1.47 points. This effect is additive: for a patient with a 5 centimeter dominant leiomyoma would on average have a 7 point greater improvement in symptom score compared with one with a 10 centimeter leiomyoma. Submucosal dominant leiomyomata also had on average an 8.7 point greater improvement in symptom score than other leiomyoma locations. Among baseline demographic factors, only age had an effect on the change in symptom scores, a relatively modest negative effect of .22 points per year increase in age. Health-related quality-of-life scores were similarly effected, as presented in the lower half of Table 3.
An analysis to further explore the effect of variables on scores showed that several affect both baseline and follow-up symptom scores and these results are presented in Table 4. In addition to affecting the change in score as noted in Table 3, predominant presenting symptom also affected the score at baseline when compared with those with other symptoms. For each of the other variables, the effect on the baseline score and the added effect noted at 6 and 12 months are presented. Some demonstrate differing effects at different intervals and provide additional insight into the change scores presented in Table 3. Larger leiomyoma size tended to result in fewer symptoms (lower score) at baseline, but the effect is opposite at 6 and 12 months, raising final symptom scores on average by 1.50 and having a net negative effect on the change in score, as seen in Table 3. Similarly, those with dominant submucosal leiomyomata had nearly 3 points worse score at baseline, but were substantially more likely to have better scores at 6 and 12 months. Other important findings are the effect of a bilateral embolization compared with unilateral. Usually, a unilateral embolization represents failure to successfully treat one half of the uterus and is likely a technical failure. There is a negative effect on symptom score for those with unilateral embolization at 6 months and an even a greater effect at 12 months. Those patients who had an adverse event during the first 30 days after the procedure had less improvement in symptom score at 6 months, and this effect persisted at 12 months. Finally, the higher the symptom score at baseline, the higher it was at 6 and 12 months, although the effect was relatively modest. For a 10-point higher (worse) symptom score at baseline, the effect was 1.5 points greater score at 6 months and 1.4 points at 12 months. There were no differences in outcome scores based on site type, site prior experience, most technical aspects of the procedure, and the other baseline variables.
Since its inception, there has been considerable interest in the outcome from uterine embolization. There have been several single center studies of outcome and these have shown 80–95% of patients have improvement in both heavy menstrual bleeding and pelvic pain and pressure symptoms.2,3,6–9 There have also been at least 2 multicenter studies that showed similar degrees of improvement.1,10 There are no current published data on a broader experience; all the reported studies have been in the context of clinical trials or case series. The Registry was designed to assess the outcome from embolization in a wider range of geographic and practice settings. This study is unusual in that it provides a window into the outcome from a procedure as it adopted into clinical care.
Overall, there is a substantial improvement in symptom and health-related quality-of-life scores by 6 months and these continued at 12 months. The mean final score for both symptom and health-related quality of life were in the range of normal when compared with the mean normal scores from the original validation. In that validation study, the mean symptom score for normals was 22.5 (± 21.1), and the mean health-related quality-of-life total score for normals was 86.4 (± 17.7).11 The results reported here are consistent, regardless of the experience of the operator or practice type. The technical aspects of the procedure also had little effect, except in the case of a technically failed procedure (unilateral embolization).
Greater changes in symptom score are noted in those presenting with heavy bleeding as the predominant symptom, which may in part reflect the greater degree of symptoms at baseline. The change in symptom score is greater in those who have received prior hormonal or medical therapy, perhaps indicating a group of patients with more severe baseline symptoms and more likely to have heavy menstrual bleeding. Increasing age had a minor effect in decreasing the change in symptom score.
The need for subsequent interventions and unanticipated hospital care was infrequent. Hysterectomy was required in 2.9% of patients, and other major interventions, such as myomectomy and repeat embolization, were less common. An unplanned visit to the emergency room or readmission occurred in 5.5% of patients in the first 6 months, but this rate declined to 3.1% of patients between 6 and 12 months. Because this is a uterine-sparing therapy, it is anticipated that there may be additional uterine interventions required in some patients over time. These will be recorded as they occur as longer-term follow-up proceeds.
There are inherent limitations with a registry design dependent on patient self-report. Patients are clearly the most reliable source for information on quality of life, especially with the use of validated, reproducible instruments. To minimize patient burden and maximize follow-up, we focused on obtaining symptom and health-related quality-of-life data using these type of instruments. We did not elicit detailed responses about specific issues, such as the frequency and cause of amenorrhea after treatment. Given the complexity of many of these issues, it is likely that more definitive conclusions regarding cause will require a more focused study, with the use of menstrual records and laboratory and imaging studies. The Registry does provide estimates of the frequency of these conditions, which will help in prioritizing and planning more detailed studies.
The method of site selection is a potential limitation becuase it was not random. Core sites were selected based on a prior minimal experience and geographic location. Although this might have resulted in a biased selection, no sites that qualified as core sites were eliminated at the outset of the study.
Data were not available for almost 20% of subjects at 12 months. If these subjects were more likely to experience unfavorable outcomes, then our results would be biased toward favorable outcomes among uterine artery embolization patients. This may be exacerbated by the lack of questionnaire responses from patients who were too ill to respond (n = 3) or who underwent hysterectomy (n = 49) by 12 months. The same liability is attached to any similar study, and the follow-up rate in the current study is similar to key large, prospective studies of hysterectomy (Kjerulff et al12 12-month retention rate 91.5%, Carlson et al13 12-month retention rate 84.9%).
Despite these limitations, this study provides insight into the outcome of a therapy through the use of a leiomyoma-specific quality-of-life questionnaire, with both an assessment of symptom status and health-related quality of life. A similar approach has been used in assessing the outcome from hysterectomy. Carlson13 studied the outcome of hysterectomy in 418 women aged between 25 and 50 years using a variety of measures, including indices of mental health, general health, and activity. These indices improved to within normal range at 6 months after surgery, although between 5% and 10% did not improve, depending on the characteristic measured. In a companion study,14 prospective cohorts were treated with either medical therapy or hysterectomy for a variety of benign conditions, including leiomyomata. That study showed hysterectomy was more effective than medical therapy for symptoms of heavy bleeding, pain, and fatigue caused by leiomyomata, and the quality of life of those treated with hysterectomy was correspondingly improved. Similar changes in quality of life and symptoms have been noted in other studies of outcome of hysterectomy.12,15 These reports demonstrate the usefulness of questionnaires (both symptom and quality of life) in assessing the effect of leiomyomata both before and after therapy.
The Registry data collection process continues, with follow-up planned at 24 and 36 months. Based on the current analysis, uterine embolization is effective in relieving the symptoms associated with uterine leiomyomata at up to 12 months after treatment for most patients, with a corresponding improvement in health-related quality of life.
1. Pron G, Bennett J, Common A, Wall J, Asch M, Sniderman K, et al. The Ontario Uterine Fibroid Embolization Trial. Part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids. Fertil Steril 2003;79:120–7.
2. Spies JB, Ascher SA, Roth AR, Kim J, Levy EB, Gomez-Jorge J. Uterine artery embolization for leiomyomata. Obstet Gynecol 2001;98:29–34.
3. Walker WJ, Pelage JP. Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up. BJOG 2002;109:1262–72.
4. Myers ER, Goodwin S, Landow W, Mauro M, Peterson E, Pron G, et al. Prospective data collection of a new procedure by a specialty society: the FIBROID Registry. Obstet Gynecol 2005;106:44–51.
5. Worthington-Kirsch R, Spies JB, Myers ER, Mulgund J, Mauro M, Pron G, et al. The Fibroid Registry for outcomes data (FIBROID) for uterine artery embolization: short-term outcomes. Obstet Gynecol 2005;106:52–9.
6. Andersen PE, Lund N, Justesen P, Munk T, Elle B, Floridon C. Uterine artery embolization of symptomatic uterine fibroida: Initial success and short-term results. Acta Radiol 2001;42:234–8.
7. Brunereau L, Herbreteau D, Gallas S, Cottier JP, Lebrun JL, Tranquart F, et al. Uterine artery embolization in the primary treatment of uterine leiomyomas: technical features and prospective follow-up with clinical and sonographic examination in 58 patients. AJR Am J Roentgenol 2000;175:1267–72.
8. Katsumori T, Nakajima K, Mihara T, Tokuhiro M. Uterine artery embolization using gelatin sponge particles alone for symptomatic uterine fibroids midterm results. AJR Am J Roentgenol 2002;178:135–9.
9. Pelage JP, LeDref O, Soyer P, Kardache M, Dahan H, Abitol M, et al. Fibroid-related menorrhagia: treatment with superselective embolization of the uterine arteries and midterm follow-up. Radiology 2000;215:428–31.
10. Spies JB, Cooper JM, Worthington-Kirsch R, Lipman JC, Mills BB, Benenati JF. Outcome from uterine embolization and hysterectomy for leiomyomas: results of a multicenter study. Am J Obstet Gynecol 2004;191:22–31.
11. Spies JB, Coyne K, Guaou Guaou N, Boyle D, Skyrnarz-Murphy K, Gonzalves SM. The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol 2002;99:290–300.
12. Kjerulff KH, Rhodes JC, Langenberg PW, Harvey LA. Patient satisfaction with the results of hysterectomy. Am J Obstet Gynecol 2000;18:1440–7.
13. Carlson KJ, Miller BA, Fowler FJ Jr. The Maine Women’s Health Study: I. Outcomes of hysterectomy. Obstet Gynecol 1994;83:556–65.
14. Carlson KJ, Miller BA, Fowler FJ Jr. The Maine Women’s Health Study: II. Outcomes of nonsurgical management of leiomyomas, abnormal bleeding, and chronic pelvic pain. Obstet Gynecol 1994;83:566–72.
15. Clarke A, Black N, Rowe P, Mott S, Howle K. Indications for and outcome of total abdominal hysterectomy for benign disease: a prospective cohort study. Br J Obstet Gynaecol 1995;102:611–20.
The Fibroid Registry for Outcomes Data (FIBROID) Investigators
FIBROID Registry Steering Committee members are listed below:
Matthew Mauro, MD, Chairman; Scott Goodwin, MD; Evan R. Myers, MD, MPH; Eric Peterson, MD, MPH; Gaylene Pron, PhD; Anne C. Roberts, MD; James B. Spies, MD; and Robert Worthington-Kirsch, MD.
FIBROID Registry Core Site Principal Investigators are listed below:
Anne Roberts, MD, University of California San Diego Medical Center, La Jolla, CA; Jeffrey Dieden, MD, Kaiser Medical Center, Oakland, CA; Mahmood Razavi, MD, Stanford University Hospital, Palo Alto, CA; Michael Hines, MD, Kaiser Permanente Hospital, Vallejo, CA; James Spies, MD, Georgetown University Hospital, Washington, DC; James Benenati, MD, Miami Cardiac and Vascular Institute, Miami, FL; Gerald Niedzwiecki, MD, Mease Countryside Hospital, Safety Harbor, FL; John Lipman, MD, Radiology Associates of Atlanta, Atlanta, GA; Robert Vogelzang, MD, Northwestern Memorial Hospital, Chicago, IL; Steven Smith, MD, LaGrange Memorial Hospital, LaGrange, IL; Karen Ehrman, MD, Methodist Hospital, Indianapolis, IN; Moises Yoselevitz, MD, Ochsner Clinic Foundation New Orleans, LA; David Brophy, MD, Mount Auburn Hospital, Cambridge, MA; Rajinder Sharma, MD, Henry Ford Hospital, Detroit, MI; William Romano, MD, William Beaumont Hospital, Royal Oak, MI; David Hovsepian, MD, Mallinckrodt Institute of Radiology, St. Louis, MO; Mark Garcia, MD, Christiana Care Health Services, Newark, DE; Gary Siskin, MD, Albany Medical Center, Albany, NY; Robert Min, MD, Cornell Vascular-New York Presbyterian Hospital, New York, NY; James Newman, MD, Cleveland Clinic Foundation, Cleveland, OH; Robert Worthington-Kirsch, MD, Delaware Valley Imaging, Philadelphia PA; Joseph Bonn, MD, Thomas Jefferson University Hospital, Philadelphia, PA; Richard Shlansky-Goldberg, MD, Hospital of the University of Pennsylvania, Philadelphia, PA; Keith Sterling, MD; INOVA Alexandria Hospital, Alexandria, VA; Joseph Gemmete, MD, University of Michigan, Ann Arbor, MI; Hyun Kim, MD, Johns Hopkins Hospital, Baltimore, MD; David Siegel, MD, Long Island Jewish Medical Center, New Hyde Park, NY.
FIBROID Registry Participating Site Investigators (United States) are listed below:
Jackeline Gomez-Jorge, MD, University of Miami/Jackson Memorial Medical Center, Miami, FL; Steven Meranze, MD, Vanderbilt University Medical Center, Nashville, TN; Abbas Chamsuddin MD, The Regional Memphis College of Medicine, Memphis, TN; Steven D. Brantley, MD, Quantum Radiology, Atlanta, GA; David J. Kastan, MD, St. Joseph Mercy Hospital, Ann Arbor, MI; Bret N. Wiechmann, MD, North Florida Regional Medical Center, Gainesville, FL; Gregory J. Dubel, MD, Rhode Island and the Miriam Hospital, Providence, RI; Jan Brekke, MD, Thunderbird Samaritan Medical Center, Glendale, AZ; Philip Amatulle, MD, Vassar Brothers Hospital, Poughkeepsie, NY; Evert-Jan Verschuyl, MD, Providence St. Peter Hospital, Olympia, WA; Peter B. Hathaway, MD, St. Mark’s Hospital, Salt Lake City, UT; Howard M. Richard III, MD, University of Maryland Medical System, Baltimore, MD; David A. Henry, MD, St. Francis Hospital, Milwaukee, WI; Kurt H. Wetzler, MD, Pitt County Memorial Hospital, Greenville, NC; Alan Zakheim, MD, Englewood Hospital and Medical Center, Englewood, NJ; Mark Cockerill, MD, Sentara Virginia Beach General Hospital, Norfolk, VA; Darryl A. Zuckerman, MD, University Hospital, Cincinnati, OH; Marcos Roffe, MD, St. Agnes Healthcare, Baltimore, MD; Linda Hughes, MD, Holy Cross Hospital, Fort Lauderdale, FL; Laura J. Hodges, MD, Greenwich Hospital, Greenwich, CT; Joel Tennenhouse, MD, St. John’s Hospital, Springfield, IL; Darren Hurst, MD, St. Elizabeth Medical Center, Edgewood, KY; Michael Miller, MD, Latrobe Area Hospital, Latrobe, PA; Adrian C. Moger, MD, Mercy Hospital, Portland, ME; Brian Baghdady, MD, Spartanburg Radiologic Associates, Spartanburg, SC; James A. York, MD, Gwinnett Medical Center, Lawrenceville, GA; Efstathios Spinos, MD, Chippenham and Johnston-Willis Medical Center, Richmond, VA; Gregory Karnaze, MD, Austin Radiological Association, Austin, TX; Keith Horton, MD, Washington Hospital Center, Washington, DC; Steven H. Peck, MD, Rose Medical Center, Denver, CO; Corito S. Tolentino, MD, El Camino Hospital, Mountain View, CA; Trevor N. Hooper MD, Gainesville Radiology Group, PC, Gainesville, GA; Gregory Gordon MD, St. Luke’s Hospital, Kansas City, MO; Lee R. Christensen, MD, St. Francis Hospital and Health Care Center, Blue Island, IL; Donald Ponec, MD, Tri-City Medical Center, Oceanside, CA; Douglas Powell, MD, Hillcrest Medical Center, Tulsa, OK; Carroll C. Overton, MD, Wake Medical Center, Raleigh, NC; Douglas C. Smith MD, Loma Linda University Medical Center, Loma Linda, CA; Thomas Velling, MD, Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Brian McInroy, MD, Holy Spirit Hospital, Mechanicsburg, PA; Jonathan Uy, MD, Franciscan Skemp Healthcare, LaCrosse, WI; Paul M. Kiproff, MD, Allegheny General Hospital, Pittsburgh, PA; John L. Nosher, MD, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ; Chad G. Kelman, MD, West Boca Medical Center, Boca Raton, FL; John E. Sunderland MD, Caritas Medical Center, Louisville, KY; Brett Storm, MD, Tallahassee Memorial Hospital, Tallahassee, FL; Brian Morrow, MD, Harbor-UCLA Medical Center, Torrence, CA; Folco Scappaticci, MD, Bristol Hospital, Bristol, CT; Neal Joseph, MD, Memorial Regional Hospital, Hollywood, FL.
FIBROID Registry Participating Site Investigators (International) are listed below:
Brian Hardy, MD, University of Manitoba, Winnipeg, Manitoba, Canada; JG Moss, MD, Gartnavel Hospital, Glasgow, Scotland; Anthony A. Nicholson, MD, Hull and East Yorkshire Hospitals Trust, Hull, England; Man-Kwong Chan, MD, Queen Elizabeth Hospital, Hong Kong, China; Grant D.K. Urquhart, MD, Southern General Hospital, Glasgow, Scotland; Neil Davies, MD, Royal Free Hospital, London, England; Raymond Ashleigh, MD, South Manchester University Hospitals NHA Trust, Manchester, England; John Clouston, MD, Wesley Hospital, Brisbane Australia; Simon Girling, MD, Norfolk and Norwich University Hospital, Norfolk, England.