Proposed Ionizing Radiation Doses of 3711 Fluoroscopy-Guided Epidural Injections

Abstract

Background: Since fluoroscopy-guided interventional therapies grew significantly in recent years, exposure to ionizing radiation (IR) either for patient or medical staff became a critical issue. IR exposure varies according to the physicians’ experience, patients’ body mass index (BMI), imaging techniques and type of the procedure performed. The purpose of this study is to calculate the reference IR doses for fluoroscopy-guided epidural injections per procedure and BMI to provide reference doses for potential use in future dose reduction strategies. Methods: A retrospectively, evaluation of patients who received epidural steroid injections between January 2015 and December 2020 in a university hospital interventional pain management center, was performed. This observational study was conducted with patients aged  18 who underwent 3711 epidural injections including cervical interlaminar, lumbar interlaminar, lumbar transforaminal and caudal approaches. Provided IR doses for each patient were also divided by patients’ BMI to obtain dose per BMI. Results: The highest IR dose per procedure was found in caudal epidural injection with 0.218 mGy m2 and lowest dose was in cervical interlaminar epidural injection with 0.057 mGy m2. The IR dose per procedure was 0.123 mGy m2 for lumbar transforaminal and 0.191 mGy m2 for lumbar interlaminar epidural injection. Caudal epidural injection had also the highest IR dose per BMI which was 0.00749 and cervical interlaminar epidural injection had the lowest radiation dose per BMI which was 0.00214. Conclusions: We proposed reference IR dose levels of four approaches of epidural injections obtained from 3711 injections performed in a university hospital pain medicine clinic. BMI of patients were taken into account with the dose levels of injections given per BMI. Multicenter research with standardized techniques will assure more reliable reference levels which will guide pain physicians to self-assess their own levels of radiation exposure.