Radiation Exposure to the Physician in Interventional Pain Management

Abstract

Fluoroscopy is an integral part of the practice of interventional pain management in present day modern medical practices. The major purpose of fluoroscopy in interventional pain management is correct needle placement to ensure target specificity and accurate delivery of the injectate. Fluoroscopy has become mandatory for multiple procedures based either on the definition of the procedure or the requirement of third parties. The most commonly used fluoroscopy in interventional pain management is with C-arm fluoroscopes with image intensification. Fluoroscopy is associated with risk for patients, clinicians, and the personnel in the operating room unless it is managed with appropriate understanding, skill, and vigilance.A total of 1,000 consecutive patients undergoing interventional procedures with chronic pain performed by one physician were studied. Two fluoroscopy units were utilized and operated by two certified radiological technologists. The procedures performed included caudal and interlaminar epidural injections, facet joint nerve blocks, percutaneous adhesiolysis, intercostal nerve blocks, sympathetic blocks, transforaminal epidural injections, along with other procedures. Results showed that a total of 1,000 patients underwent 1,729 procedures with average radiation exposure of 13.2 ± 0.33 seconds per patient and 7.7 ± 0.21 seconds per procedure. Dosimetry measurements showed total exposure of 1,345 mREM outside the apron and 0 mREM inside the apron during this period. The average exposure outside the apron was 1.345 mREM per patient and 0.748 mREM per procedure outside the apron and 0 mREM inside the apron. The levels of exposure are significantly below the annual limits recommended. It is concluded that it is feasible to perform all procedures under fluoroscopy in the described setting safely and effectively in interventional pain management.

Comparison of radiation exposure to physicians between anteroposterior and lateral real-time fluoroscopy when performing lumbar transforaminal epidural steroid injections: A randomized controlled trial

“…[ 11 ] First, the X-ray tube should be positioned beneath the operating table to reduce backscattered radiation, and the physician should stand as far away as possible from the X-ray tube during AP fluoroscopy. [ 6 , 8 , 10 , 19 , 20 ] The same applies to lateral fluoroscopy, that is, the scattered radiation on the side of X-ray tube is 2 to 3 times higher than the side of image intensifier. [ 21 ] Therefore, physicians are recommended to stand on the side of the image intensifier or stay at least >1 m away from the X-ray tube.…”

Radiation safety for pain physicians: principles and recommendations

“…Therefore, in situations where the primary X-ray dose is high, the scattered radiation dose is also high. Even for the same primary X-ray dose, the scattered radiation dose varies depending on the distance from the X-ray generator to the table and patient [ 14 ].…”

“…When a lateral view is taken ( Fig. 2B ), more scattered radiation is generated on the side where the X-ray generator is located [ 14 ]. Thus, the staff on the side of the X-ray generator will have a higher radiation exposure than will the staff on the opposite side.…”

“…When an image is taken with the X-ray generator (red circle) positioned below (A), more scattered radiation is generated in the lower extremities of the physician and medical staff [ 9 ]. When a lateral view is taken (B), more scattered radiation is generated on the side where the X-ray generator is located [ 14 ]. If the flat panel detector is positioned downwards to obtain an image (C), a large amount of scattered radiation is generated to the upper body, neck, and head.…”

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

“…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.…”