C-arm fluoroscopy is useful equipment in interventional pain management because it helps to guide correct needle targeting for the accurate injection and drug delivery. However, due to increased use of C-arm fluoroscopy in various pain procedures, the risk of radiation exposure is a significant concern for pain physicians. The harmful biological effects of ionizing radiation on the human body are well known. It is therefore necessary to strive to reduce radiation exposure. Lead aprons with thyroid shields are the most fundamental radiation protective devices for interventional procedures, and are very effective. However, the operator's radiation safety cannot be guaranteed because pain physicians seem to lack sufficient interest, knowledge, and awareness about radiation safety. Also, inappropriate care and use of radiation protective devices may result in a higher risk of radiation exposure. The purpose of this article was to review the literature on radiation safety with a focus on lead aprons and thyroid shields and present recommendations related to those devices during C-arm fluoroscopic-guided interventions by pain physicians.

BackgroundThe physician's hands are close to the X-ray field in C-arm fluoroscopy-guided pain interventions. We prospectively investigated the radiation attenuation of Proguard RR-2 gloves.MethodsIn 100 cases, the effective doses (EDs) of two dosimeters without a radiation-reducing glove were collected. EDs from the two dosimeters-one dosimeter wrapped with a glove and the other dosimeter without a glove- were also measured at the side of the table (Group 1, 140 cases) and at a location 20 cm away from the side of the table (Group 2, 120 cases). Mean differences such as age, height, weight, radiation absorbed dose (RAD), exposure time, ED, and ratio of EDs were analyzed.ResultsIn the EDs of two dosimeters without gloves, there were no significant differences (39.0 ± 36.3 µSv vs. 38.8 ± 36.4 µSv) (P = 0.578). The RAD (192.0 ± 182.0 radcm2) in Group 2 was higher than that (132.3 ± 103.5 radcm2) in Group 1 (P = 0.002). The ED (33.3 ± 30.9 µSv) of the dosimeter without a glove in Group 1 was higher than that (12.3 ± 8.8 µSv) in Group 2 (P < 0.001). The ED (24.4 ± 22.4 µSv) of the dosimeter wrapped with a glove in Group 1 was higher than that (9.2 ± 6.8 µSv) in Group 2 (P < 0.001). No significant differences were noted in the ratio of EDs (73.5 ± 6.7% vs. 74.2 ± 9.3%, P = 0.469) between Group 1 and Group 2.ConclusionsProguard RR-2 gloves have a radiation attenuation effect of 25.8-26.5%. The radiation attenuation is not significantly different by intensity of scatter radiation or the different RADs of C-arm fluoroscopy.

Celiac plexus neurolysis (CPN) is an ablative procedure of the celiac plexus, which aims to destroy afferent pain-transmitting fibers from the abdominal viscera. CPN is a relatively safe procedure; it is associated with several relatively common and mostly transient complications, such as local pain (96%), hypotension (10%), and diarrhea (44%) [1]. However, severe complications of CPN can include neurologic injuries such as paraplegia and anal and bladder sphincter dysfunction. Herein, we report a case of paraplegia by acute spinal cord infarction after CPN with alcohol. CASE REPORTA 65-year-old male patient (height, 166 cm; weight, 69 kg) was referred from the Department of Oncology for the management of epigastric pain caused by pancreatic cancer with peritoneal seeding. The patient had previously been treated for hypertension and diabetes. While undergoing 6 cycles of chemotherapy, he received dalteparin (10,000 IU) as treatment for pulmonary thromboembolism with deep vein thrombosis. For pain control, a 100 µg/h fentanyl patch was applied to the skin, and an average of 4 mg/h of morphine was administered intravenously. However, the patient complained of continuous pain (visual analog scale score 5/10; 0 = no pain, 10 = the most severe pain imaginable), so a C-arm fluoroscopic-guided CPN was performed. Before the procedure, the patient was fully informed of its potential complications.The patient lay in the prone position while undergoing the C-arm fluoroscopic-guided bilateral CPN at the L1 level using