Fluoroscopy Procedure and Equipment Changes to Reduce Staff Radiation Exposure in the Interventional Spine Suite

Abstract

Background: Fluoroscopic guided percutaneous interventional spine procedures are increasingly performed in recent years as they have been shown to be target specific and enhance patient safety. However, ionizing radiation has been associated with stochastic effects such as cancer and genetic defects as well as deterministic effects such as cataracts, erythema, epilation, and even death. These are dose related, and hence, measures should be taken to minimize radiation exposure to patients and health care personnel to reduce these adverse effects. Objective: A risk reduction project was completed with the goal of reducing effective doses to the staff and patients in a university-based spinal interventional practice. Effective dose reduction to the staff and patients was hypothesized to occur with technique and equipment changes in the procedure suite. The goal of this study was to quantify effective dose rates to staff before and after interventions. Study Design: Retrospective study comparing descriptive data of effective dose to the health care staff before and after implementation of a combination of technique and equipment changes. Methods: Technique changes from pre to post intervention period included continuous needle advancement under continuous fluoroscopic controlled by the interventional physician to intermittent needle advancement under pulsed fluoroscopic controlled by the radiology technician. Equipment changes included circumferential lead drape skirt around the procedure table and use of mobile transparent lead barriers on both sides of the procedure table. Effective dose exposure measured in Millirem (mrem) from the radiation dosimetry badges for pre-intervention (February 2009 through June 2009) and post-intervention (November 2009 through March 2010) periods were examined through monthly radiation dosimetry reports for the fluoroscopy suite staff. Results: A total of 685 interventional procedures were performed in the pre-intervention period and 385 in the post-intervention period. The median cumulative mrem (interquartile range) for all staff combined in the pre-intervention period was 71 (28,75) and post-intervention period was 1 (0,3). The median mrem per procedure was significantly higher in the pre-intervention group 0.46 (0.36, 0.54) compared to post-intervention 0.01 (0.0.03); P < 0.01. The percentage reduction in overall effective dose per procedure to all staff was 97.3%. Limitations: Observational study, multiple radiation reduction interventions confound the individual effects of each intervention’s effective dose Conclusions: Spinal injection technique and equipment changes in the procedure suite significantly reduced the rate of effective dose to the clinical staff. Key words: Fluoroscopy, effective radiation dose, spine

Development of a Cadaver Laboratory Curriculum for Interventional Spine Procedures for Physical Medicine and Rehabilitation Residents

“…Next, to maximize distance, the participants were instructed to take at least one step back from the C-arm before any images being taken. Last, shielding was strictly enforced for all participants in the form of lead vests, thyroid shields, and lead glasses 6,7 . Residents were reminded that increased radiation exposure among physicians using fluoroscopy can cause negative health effects, including erythema, cataracts, cancer, or even death.…”

Radiation Exposure and Safety Considerations in Interventional Radiology: Comparison of a Twin Robotic X-ray System to a Conventional Angiography System

“…Of note, Li et al reported alarmingly high effective doses in a substantial number of patients who had one or more FGP [6]. A combination of training, protective equipment, and technological innovations have the potential to reduce radiation exposure in the interventional radiology suite [7][8][9][10][11]. The precautionary guidelines of the International Atomic Energy Agency (IAEA) should be used when working with radiation.…”

Advanced integration of stereotaxis and real-time MRI for precise and safe medical navigation: a future paradigm for minimally invasive interventions

“…Also, when fluoroscopy is used, both the patient and the medical staff are exposed to ionizing radiation, which could be harmful to their health (Giordano et al, 2008) (Frane & Bitterman, 2020) (Bang et al, 2020) (Plastaras et al, 2013). Reducing radiation exposure is important for keeping patients safe and protecting healthcare workers who are often exposed to imaging methods that use radiation (Ploussi & Efstathopoulos, 2016) (Le Heron et al, 2010) (Furlow, 2011).…”