Reducing Patient Radiation Dose during CT-Guided Procedures: Demonstration in Spinal Injections for Pain

Abstract

BACKGROUND AND PURPOSE:CT guidance may improve precision for diagnostic and therapeutic spinal injections, but it can increase patient radiation dose. This study examined the impact of reducing tube current on patient radiation exposure and the technical success for these procedures, by using axial acquisitions for short scan lengths and eliminating nonessential imaging.

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.…”

Lateral Decubitus Positioning for Cervical Nerve Root Block Using CT Image Guidance Minimizes Effective Radiation Dose and Procedural Time

“…With intermittent CT guidance, the ED was lower than that reported previously in diagnostic neck CT. 15 Adding previously reported dose-reduction techniques might reduce the expected patient dose further. 16 Several authors have previously discussed radiation exposures to the operator and patients during image-guided procedures by using fluoroscopy, CT fluoroscopy, and intermittent CT without specifically addressing the ED. 9,16 Because all images are acquired with the operator in the CT control room, dose to the operators is zero with this technique.…”

“…16 Several authors have previously discussed radiation exposures to the operator and patients during image-guided procedures by using fluoroscopy, CT fluoroscopy, and intermittent CT without specifically addressing the ED. 9,16 Because all images are acquired with the operator in the CT control room, dose to the operators is zero with this technique. An anatomically relevant constant was calculated to more accurately define an ED for the procedure.…”

CT-Guided Lumbar Nerve Root Injections: Are We Using the Correct Radiation Dose Settings?

“…As a result, there is wide variability in the reported tube current settings for lumbar spine CT fluoroscopy procedures. [3][4][5][6][7] The aim of this study was to compare the tube current selection and fluoroscopy time of different proceduralists for lumbar spine SNRB in our practice. We sought to learn the variability in tube current to help us form strategies for optimizing CT fluoroscopy utility, while keeping radiation dose as low as reasonably achievable.…”