Factors Related to Radiation Exposure during Lumbar Spine Intervention

Abstract

Fluoroscopy guidance is useful to confirm anatomical landmark and needle location for spine intervention; however, it can lead to radiation exposure in patients, physicians, and medical staff. Physicians who used fluoroscopy should be cognizant of radiation exposure and intend to minimize radiation dose. We retrospectively reviewed three lumbar spine intervention procedures (nerve root block, medial branch block, and facet joint block) at our institution between June and December, 2014. We performed 268 procedures on 220 patients and found significant difference in radiation dose between two groups classified by performing physicians. The physician who controlled the fluoroscopy unit directly used significantly shorter fluoroscopy (6 seconds) that resulted in a smaller radiation dose (dose area product [DAP] 0.59 Gy∙cm2) than the physician supervising the radiographer controlling the fluoroscopy unit (72 seconds, DAP 5.31 Gy∙cm2, P < 0.001). The analysis indicates that the difference in fluoroscopy time depends on whether a physician or a radiographer controls the fluoroscopy unit.

Radiation Exposure during Fluoroscopy-Guided Ozone Chemonucleolysis for Lumbar Disc Herniation

“…Second, Somma et al did not report if the physician who was performing OCN was directly controlling the fluoroscopy unit, or if the physician had supervised the radiographer while performing OCN. This element should also be considered because a different radiation exposure was found in the two different conditions [37]. Finally, two different fluoroscopy devices were used for OCN in our study than by Somma et al…”

Proposed Ionizing Radiation Doses of 3711 Fluoroscopy-Guided Epidural Injections

“…Long-term exposure to even low dose of radiation is now believed to have harmful effects, hence mitigating exposure to physicians performing interventional techniques is of utmost importance. Wearing lead aprons, maximizing the distance from the radioactive source, minimizing exposure time, avoiding magnification and increasing use of collimation are the main strategies to reduce radiation exposure with respect to ALARA principle [3,12] Aforementioned recommendations are often oversight; besides, physicians need reference level standards to assure quality controls. There is paucity of data regarding reference dose standards for epidural injections and available research have been focused on comparing radiation exposure for computed tomography or fluoroscopy-guided injections or conducted with relatively small sample sizes without available reference levels [13][14][15].…”

“…Radiation exposure varies according to the physicians' experience, patients' body mass index (BMI), imaging techniques (such as magnification), type of the procedure performed. As low as reasonably achievable (ALARA) principle is recommended to minimize the risk of acute and estimated effects of ionizing radiation [3].…”