Coaching Reduced the Radiation Dose of Pain Physicians by Half during Interventional Procedures

Abstract

The increased use of C-arm fluoroscopy in interventional pain management has led to higher radiation exposure for pain physicians. This study investigated whether or not real-time radiation dose feedback with coaching can reduce the scatter dose received by pain physicians. Firstly, phantom measurements were made to create a scatter dose profile, which visualizes the average scatter radiation for different C-arm positions at 3 levels of height. Secondly, in the clinical part, the radiation dose received by pain physicians during pain treatment procedures was measured real-time to evaluate (1) the effect of real-time dose feedback on the received scatter dose, and (2) the effect of knowledge of the scatter dose profile and active coaching, on the scatter dose received by the pain physician. The clinical study included 330 interventional pain procedures. The results showed that real-time feedback of the received dose did not lead to a reduction in scatter radiation. However, visualization of the scatter dose in a scatter dose profile and active coaching on optimal positions did reduce the scatter radiation received by pain physicians during interventional pain procedures by 46.4% (P = 0.05). Knowledge of and real-time coaching with the scatter dose profile reduced the dose of pain physicians by half, caused by their increased awareness for scatter radiation and their insight into strategic positioning.

Radiation safety: a focus on lead aprons and thyroid shields in interventional pain management

“…However, procedures with real-time monitoring of the scattered dose profile did not have significantly different exposure levels than procedures without monitoring, presumably because of the shorter procedure time without monitoring. However, real-time coaching on the appropriate position for dose reduction while monitoring the scattered radiation dose increased the physician's awareness of the scattered radiation, reducing the radiation dose to the pain physician by half [ 54 ].…”

An Artificial Neural Network Predicts the Excessive Radiation Risk in Epidural Pulsed Radiofrequency (Eprf) Interventions- A Pilot Study

“…Since then, the issue of radiation exposure has been extensively addressed during different types of diagnostic procedures and surgeries, such as in lumbar discography [37][38][39][40], in vertebroplasty [39,40], in kyphoplasty [41], in minimally invasive transforaminal lumbar interbody fusion [42], and in pedicle screw insertion in the lumbar spine [43][44][45]. In pain practice, the radiation levels were explored during lumbar epidural steroid injections [38,[46][47][48][49][50][51][52], in medial branch blocks and facet joint injections [38,[50][51][52][53][54], in intercostal blocks [51], in stellate ganglion blocks [55], and in percutaneous adhesiolysis [51]. [36,[56][57][58], in the eyes [58][59][60], in glands (thyroid, parotid) [58], and in several other tissues (breast, lung, bone, blood) [58,[61][62][63].…”

Reducing Radiation Exposure in Lumbar Transforaminal Epidural Steroid Injections with Pulsed Fluoroscopy: A Randomized, Doubleblind, Controlled Clinical Trial

“…Two of the 5 physicians in the study routinely used lateral fluoroscopic views, which greatly increase radiation dose and scatter. Interestingly, a 2015 study of interventional pain procedures found that scatter was reduced by 46.4% simply by realtime coaching on ideal physician and C-arm positioning, without any adjustment of radiation dose settings (28).…”