Fluoroscopically guided transforaminal epidural steroid injections at a quaternary-care teaching institution: effect of trainee involvement and patient body mass index on fluoroscopy time and patient dose

Tiegs‐Heiden, Christin A.; Murthy, Naveen S.; Geske, Jennifer R.; Diehn, Felix E.; Schueler, Beth A.; Wald, John T.; Kaufmann, Timothy J.; Lehman, Vance T.; Carr, Carrie M.; Amrami, Kimberly K.; Morris, Jonathan M.; Thielen, Kent R.; Maus, Timothy P.

doi:10.1016/j.crad.2015.10.003

Cited by 11 publications

(11 citation statements)

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“…9,10 The current study demonstrated a statistically significant increase in both fluoroscopy dose and skin dose with increasing BMI, including when controlling for other variables, again consistent with prior research. 8,10 Additionally, BMI and fluoroscopy time demonstrated a significant interaction upon skin dose, with increasing time leading to larger increases in skin dose as BMI increased (Figure 2). BMI was not associated with the injectate flow pattern achieved in both regression analysis and descriptive statistics.…”

Section: Discussionmentioning

confidence: 98%

“…However, fluoroscopy carries risks of radiation exposure to both practitioner and patient, with increased exposure in obese patients and those undergoing serial injections. 8 It is widely accepted that keeping radiation dosage as low as reasonably achievable (ALARA) is paramount. Even as improved technology aids in reducing radiation dose, the ALARA principle remains important to patients and practitioners who may be exposed to numerous radiation-generating imaging studies over the course of their lifetime.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, understanding what may impact procedural radiation doses to both patient and proceduralist continues to be studied. [8][9][10][11][12][13][14][15] In addition, a proceduralist should fully understand which factors may impact the intraprocedural course and ultimate outcome of each procedure.…”

Section: Introductionmentioning

confidence: 99%

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Impact of flow pattern, body mass index, and age on intraprocedural fluoroscopic time and radiation dose during sacroiliac joint injections

et al. 2021

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Purpose Understanding all factors that may impact radiation dose and procedural time is crucial to safe and efficient image-guided interventions, such as fluoroscopically guided sacroiliac (SI) joint injections. The purpose of this study was to evaluate the effect of flow pattern (intra- vs. periarticular), patient age, and body mass index (BMI) on radiation dose and fluoroscopy time. Methods A total of 134 SI joint injections were reviewed. Injectate flow pattern, age, and BMI were analyzed in respect to fluoroscopy time (minutes), radiation dose (kerma area product (KAP); µGy m2), and estimated skin dose (mGy). Results BMI did not affect fluoroscopy time, but increased BMI resulted in significantly higher skin and fluoroscopy doses ( p < 0.001). There was no association between fluoroscopy time and flow pattern. Higher skin dose was associated with intraarticular flow ( p = 0.0086), and higher KAP was associated with periarticular flow ( p = 0.0128). However, the odds ratios were close to 1. There was no significant difference between fluoroscopy time or dose based on patient age. Conclusion Increased BMI had the largest impact on procedural radiation dose and skin dose. Flow pattern also showed a statistically significant association with radiation dose and skin dose, but the clinical difference was small. Proceduralists should be aware that BMI has the greatest impact on fluoroscopy dose and skin dose during SI joint injections compared to other factors.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Impact of flow pattern, body mass index, and age on intraprocedural fluoroscopic time and radiation dose during sacroiliac joint injections

et al. 2021

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“…9,10 Numerous studies evaluating spinal pain procedures take place in private clinics, 11,12 which are not comparable with academic institutions. 13,14 In teaching hospitals, patients often have more medical comorbidities, technologists are generally less specialized as they rotate between departments, and learners participate in patient care. Some academic center-based studies assessing radiation exposure do not consider the presence of clinicians in training.…”

Section: Introductionmentioning

confidence: 99%

Influence of resident involvement on fluoroscopy time and ionizing radiation exposure in fluoroscopy‐guided spinal procedures

Soucy,

Lee,

Moreau‐Bourbonnais

et al. 2023

PM&R

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BackgroundFluoroscopic guidance has become the standard for a variety of medical procedures. Mastering these techniques requires practice, which may entail additional radiation for patients and providers. Despite their widespread use, the literature examining factors influencing radiation exposure in fluoroscopically guided pain procedures is scarce.ObjectiveTo evaluate the influence of resident involvement on radiation exposure during fluoroscopy‐guided spinal interventions.DesignSingle‐center, observational study.SettingOutpatient physiatry clinic in a teaching hospital.PatientsAll patients who received cervical or lumbar facet block(s) (FBs), transforaminal epidural steroid injection(s) (TFESIs) without digital subtraction, or a caudal epidural (CE) during the study period were included.InterventionsResident involvement in the procedures: absent, observing, or participating.Main Outcome MeasuresMachine‐indicated fluoroscopy time (seconds) and radiation dose (milligrays [mGy]).ResultsTwo hundred ninety six procedures were included: 188 FBs (58 cervical, 130 lumbar), 48 CEs, and 60 TFESIs. For lumbar FBs, fluoroscopy time and radiation dose increased significantly when residents performed them (meantime = 24.5 s, confidence interval [CI] = 20.4–28.7; meandose = 3.53 mGy, CI = 2.57–4.49) compared to when they observed (meantime = 9.9 s, CI = 8.1–11.7; meandose = 1.28 mGy, CI = 0.98–1.59) (mean difference: time = 14.63 s, CI = 9.31–19.94; dose = 2.25 mGy, CI = 1.17–3.33) and were absent during the procedure (meantime = 12.9 s, CI = 11.1–14.6; meandose = 1.65 mGy, CI = 1.40–1.89) (mean difference: time = 11.67 s, CI = 7.35–15.98; dose = 1.88 mGy, CI = 1.01–2.76). In the case of TFESIs, time, but not dose, increased significantly when residents observed (meantime = 39.1 s, CI = 30.7–47.6; meandose = 6.73 mGy, CI = 3.39–10.07) compared to when they were absent (meantime = 27.1 s, CI = 22.4–31.8; meandose = 4.41 mGy, CI = 3.06–5.76 (mean difference: time = 11.99 s, CI = 1.37–22.61; dose = 2.32 mGy, CI = −1.20–5.84). Finally, resident involvement did not significantly affect the outcomes for CEs (ptime = .032, pdose = .74) and cervical FBs (ptime = .64, pdose = .68).ConclusionResident participation affected lumbar FBs the most, with an increase in both fluoroscopy time and radiation dose.

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“…In a previous report, the involvement of musculoskeletal and neuroradiology fellows in TFESI did not prolong fluoroscopy time and/or increase the radiation dose. 3 But how do beginners do in TFESI? We describe the learning curves and associated complications of four neurosurgery residents never previously exposed to TFESI and compare them with experienced board-certified faculty neurosurgeons (BCFNs).…”

Section: Introductionmentioning

confidence: 99%

Residents' Learning Curve of Lumbar Transforaminal Epidural Steroid Injections

Joswig

Haile

Hildebrandt

et al. 2017

J Neurol Surg A Cent Eur Neurosurg

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Background and Study Aims There is a paucity of literature on beginners' training and on its connection with patient safety for transforaminal epidural steroid injections (TFESIs). This study retrospectively assessed the learning curves and associated complications of neurosurgery residents never previously exposed to TFESI and compared them with experienced board-certified faculty neurosurgeons (BCFNs). Material and Methods Procedure time in minutes, dose-area product (DAP) in cGy*cm2, periprocedural observations, and complications in 354 TFESIs for radicular pain secondary to lumbar disk herniation or lumbar spinal stenosis were extracted from operative notes and the electronic infiltration logbook in the per-injection format. Learning curves for 238 residents and 116 BCFN TFESIs in terms of procedure time and DAP were estimated using monotone regression. Results Residents' TFESI procedure time and DAP reached BCFN level (4.7 minutes and 140.2 Gy*cm2) after 67 and 68 cases, respectively. Residents' TFESIs were unsuccessful in 1.7%, mostly for severe obesity and hypertrophied facet joints, but no severe complications were noted. Obesity, however, did not result in increased procedure times or radiation exposure in general. Residents were faster and required less fluoroscopy in TFESI of the upper lumbar nerve roots than for L5 or S1 in particular. Conclusion The residents' learning curve for TFESIs in terms of procedure time and radiation exposure can be overcome safely after < 70 TFESIs. An outcome analysis correlating to the interventionalist's training level would be worth investigating in future studies.

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Fluoroscopically guided transforaminal epidural steroid injections at a quaternary-care teaching institution: effect of trainee involvement and patient body mass index on fluoroscopy time and patient dose

Cited by 11 publications

References 10 publications

Impact of flow pattern, body mass index, and age on intraprocedural fluoroscopic time and radiation dose during sacroiliac joint injections

Impact of flow pattern, body mass index, and age on intraprocedural fluoroscopic time and radiation dose during sacroiliac joint injections

Influence of resident involvement on fluoroscopy time and ionizing radiation exposure in fluoroscopy‐guided spinal procedures

Residents' Learning Curve of Lumbar Transforaminal Epidural Steroid Injections

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