Influence of resident involvement on fluoroscopy time and ionizing radiation exposure in fluoroscopy‐guided spinal procedures

Abstract

BackgroundFluoroscopic guidance has become the standard for a variety of medical procedures. Mastering these techniques requires practice, which may entail additional radiation for patients and providers. Despite their widespread use, the literature examining factors influencing radiation exposure in fluoroscopically guided pain procedures is scarce.ObjectiveTo evaluate the influence of resident involvement on radiation exposure during fluoroscopy‐guided spinal interventions.DesignSingle‐center, observational study.SettingOutpatient physiatry clinic in a teaching hospital.PatientsAll patients who received cervical or lumbar facet block(s) (FBs), transforaminal epidural steroid injection(s) (TFESIs) without digital subtraction, or a caudal epidural (CE) during the study period were included.InterventionsResident involvement in the procedures: absent, observing, or participating.Main Outcome MeasuresMachine‐indicated fluoroscopy time (seconds) and radiation dose (milligrays [mGy]).ResultsTwo hundred ninety six procedures were included: 188 FBs (58 cervical, 130 lumbar), 48 CEs, and 60 TFESIs. For lumbar FBs, fluoroscopy time and radiation dose increased significantly when residents performed them (meantime = 24.5 s, confidence interval [CI] = 20.4–28.7; meandose = 3.53 mGy, CI = 2.57–4.49) compared to when they observed (meantime = 9.9 s, CI = 8.1–11.7; meandose = 1.28 mGy, CI = 0.98–1.59) (mean difference: time = 14.63 s, CI = 9.31–19.94; dose = 2.25 mGy, CI = 1.17–3.33) and were absent during the procedure (meantime = 12.9 s, CI = 11.1–14.6; meandose = 1.65 mGy, CI = 1.40–1.89) (mean difference: time = 11.67 s, CI = 7.35–15.98; dose = 1.88 mGy, CI = 1.01–2.76). In the case of TFESIs, time, but not dose, increased significantly when residents observed (meantime = 39.1 s, CI = 30.7–47.6; meandose = 6.73 mGy, CI = 3.39–10.07) compared to when they were absent (meantime = 27.1 s, CI = 22.4–31.8; meandose = 4.41 mGy, CI = 3.06–5.76 (mean difference: time = 11.99 s, CI = 1.37–22.61; dose = 2.32 mGy, CI = −1.20–5.84). Finally, resident involvement did not significantly affect the outcomes for CEs (ptime = .032, pdose = .74) and cervical FBs (ptime = .64, pdose = .68).ConclusionResident participation affected lumbar FBs the most, with an increase in both fluoroscopy time and radiation dose.