Radiation dose reduction in CT-guided sacroiliac joint injections to levels of pulsed fluoroscopy: a comparative study with technical considerations

Abstract

BackgroundThe sacroiliac (SI) joint is frequently the primary source of low back pain. Over the past decades, a number of different SI injection techniques have been used in its diagnosis and therapy. Despite the concerns regarding exposure to radiation, image-guided injection techniques are the preferred method to achieve safe and precise intra-articular needle placement. The following study presents a comparison of radiation doses, calculated for fluoroscopy and CT-guided SI joint injections in standard and low-dose protocol and presents the technical possibility of CT-guidance with maximum radiation dose reduction to levels of fluoroscopic-guidance for a precise intra-articular injection technique.ObjectiveTo evaluate the possibility of dose reduction in CT-guided sacroiliac joint injections to pulsed-fluoroscopy-guidance levels and to compare the doses of pulsed-fluoroscopy-, CT-guidance, and low-dose CT-guidance for intra-articular SI joint injections.Study designComparative study with technical considerations.MethodsA total of 30 CT-guided intra-articular SI joint injections were performed in January 2012 in a developed low-dose mode and the radiation doses were calculated. They were compared to 30 pulsed-fluoroscopy-guided SI joint injections, which were performed in the month before, and to five injections, performed in standard CT-guided biopsy mode for spinal interventions. The statistical significance was calculated with the SPSS software using the Mann–Whitney U-Test. Technical details and anatomical considerations were provided.ResultsA significant dose reduction of average 94.01% was achieved using the low-dose protocol for CT-guided SI joint injections. The radiation dose could be approximated to pulsed-fluoroscopy- guidance levels.ConclusionRadiation dose of CT-guided SI joint injections can be decreased to levels of pulsed fluoroscopy with a precise intra-articular needle placement using the low-dose protocol. The technique is simple to perform, fast, and reproducible.

Radiation Dose Reduction in CT-Guided Spine Biopsies Does Not Reduce Diagnostic Yield

“…One study found that a change in CT parameters to lower radiation dose resulted in an 86% reduction in total DLP (from 1458 mGy⅐cm to 199 mGy⅐cm) for CT-guided spine injection procedures for pain. 17 Artner et al 18 demonstrated that the dose related to CTguided sacroiliac joint injections can be significantly reduced to levels of pulsed fluoroscopy without compromising needle placement into the joint. In this study, we found a significantly reduced radiation dose as expressed by CTDIvol and DLP in patients undergoing CTguided spine biopsies using a low-dose protocol compared with a regular-dose protocol.…”

“…[9][10][11][12][13][14] This type of protocol modification has also been used in CT-guided interventions to limit radiation dose when performing multiple scans during the procedure. 8,[15][16][17][18] Given the increased desire to reduce radiation dose to patients, we transitioned our protocols for CT-guided spine biopsies to use a lower dose. The purpose of this study was to demonstrate that a low-dose protocol for CT-guided spine biopsies is as effective in tissue sampling without an increase in procedural time or an increase in complication rates compared with our legacy higher-dose approaches.…”

Reduction of radiation dose in adult CT-guided musculoskeletal procedures

“…This is less than the 87% dose reduction demonstrated by Patel et al for musculoskeletal biopsies in the pediatric population and less than the 85-94% dose reductions achieved by Artner et al for spinal, periradicular, and sacroiliac joint injections [2,[5][6][7]. As we experienced no loss in procedural success, this suggests that we may have room to further decrease radiation doses.…”

Spinal Injections for Pain Management

“…The radiation dose of CT interventions can be decreased to the level of fluoroscopic interventions by using a low-dose protocol that eliminates acquisition of a topogram, minimizes both energy and tube current, and severely restricts the number of image acquisitions during needle placement (86)(87)(88). At institutions where interventional CT is a limited resource, CT-guided injections for pain management can be challenging to schedule if they must compete for scanner time with biopsy, oncologic ablation, and abscess drainage procedures.…”