Radiation Dose Exposure for Lumbar Spine Epidural Steroid Injections: A Comparison of Conventional Fluoroscopy Data and CT Fluoroscopy Techniques

Hoang, Jenny K.; Yoshizumi, Terry T.; Toncheva, Greta; Gray, Linda; Gafton, Andreia R.; Huh, Billy K.; Eastwood, James D.; Lascola, Christopher D.; Hurwitz, Lynne M.

doi:10.2214/ajr.10.6102

Cited by 58 publications

(35 citation statements)

References 13 publications

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“…However, the increase in effective dose caused by the need for a spiral CT scan for better localization of the cervical nerve root and planning of the access was lower for the cervical spine than for the lumbar spine. Although such a scan was necessary in 17 of 64 cases in our study and the average effective dose of 0.85 mSv was significantly higher, the increase in the study of Hoang et al [39] was up to 2.9 mSv for the lumbar spine. Since MRI-guided nerve root infiltration does not require radiation exposure for patients and personnel, it should be used primarily in patients with expected severe degenerative changes of the cervical spine, in the case of an anticipated serial therapy regimen, and in younger patients.…”

Section: Discussioncontrasting

confidence: 52%

“…The radiation exposure needed for CT fluoroscopic guidance has a potentially damaging effect on patients and personnel [15 -17] and is of importance because many patients often require multiple interventions to achieve lasting pain relief. Hoang et al [39] and Schmid et al [40] documented the average effective dose in CT-guided nerve root infiltrations with the help of a phantom model and calculated average effective dose values of 0.45 mSv and between 0.22 -0.45 mSv. A similar average dose value of 0.48 mSv (approximated) was achieved in our study.…”

Section: Discussionmentioning

confidence: 99%

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MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison

Maurer

Froeling

Röttgen

et al. 2013

Fortschr Röntgenstr

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Purpose: To evaluate and compare the costs of MRI-guided and CT-guided cervical nerve root infiltration for the minimally invasive treatment of radicular neck pain. Materials and Methods: Between September 2009 and April 2012, 22 patients (9 men, 13 women; mean age: 48.2 years) underwent MRI-guided (1.0 Tesla, Panorama HFO, Philips) single-site periradicular cervical nerve root infiltration with 40?mg triamcinolone acetonide. A further 64 patients (34 men, 30 women; mean age: 50.3 years) were treated under CT fluoroscopic guidance (Somatom Definition 64, Siemens). The mean overall costs were calculated as the sum of the prorated costs of equipment use (purchase, depreciation, maintenance, and energy costs), personnel costs and expenditure for disposables that were identified for MRI- and CT-guided procedures. Additionally, the cost of ultrasound guidance was calculated. Results: The mean intervention time was 24.9 min. (range: 12???36?min.) for MRI-guided infiltration and 19.7?min. (range: 5???54?min.) for CT-guided infiltration. The average total costs per patient were EUR 240 for MRI-guided interventions and EUR 124 for CT-guided interventions. These were (MRI/CT guidance) EUR 150/60 for equipment use, EUR 46/40 for personnel, and EUR 44/25 for disposables. The mean overall cost of ultrasound guidance was EUR 76. Conclusion: Cervical nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. However, since it does not involve radiation exposure for patients and personnel, MRI-guided nerve root infiltration may become a promising alternative to the CT-guided procedure, especially since a further price decrease is expected for MRI devices and MR-compatible disposables. In contrast, ultrasound remains the less expensive method for nerve root infiltration guidance. Citation Format: ??Maurer MH, Froeling V, R?ttgen R et?al. MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison. Fortschr R?ntgenstr 2014; 186: 559???566

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison

Maurer

Froeling

Röttgen

et al. 2013

Fortschr Röntgenstr

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“…Based on the results of our study, we recommend a tube current of 40 mA or less for a body AP diameter of Յ30 cm. This technique of stratifying patients by body size could also be used for selecting tube current for the planning CT, as prior studies have shown that the greatest contributor to dose for CT-guided lumbar injections is the planning CT. 5 There are several limitations to this study. First, this is a retrospective study of a small number of patients at a single academic institution.…”

Section: Discussionmentioning

confidence: 94%

“…In the lumbar spine, CT guidance offers advantages over conventional fluoroscopy of improved soft tissue resolution, 1 improved precision in needle placement, 2,3 and decreased procedure time. 4,5 However, because of the higher tube current for CT compared with conventional fluoroscopy, when possible, proceduralists need to be mindful of radiation dose optimization and minimize dose.…”

mentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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

Schauberger¹,

Kranz²,

Choudhury³

et al. 2012

AJNR Am J Neuroradiol

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Review of air kerma‐area product, effective dose and dose conversion coefficients for non‐cardiac interventional fluoroscopy procedures

Miller

2020

Medical Physics

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Purpose To provide current data on average air kerma‐area product (PKA) and effective dose (E) for noncardiac interventional fluoroscopy procedures and suggested values of dose coefficients (DCE) for conversion of PKA to estimates of effective dose. Methods A PubMed literature search covering the time period from 2006 to August 2019 was performed to obtain recent data on PKA, E and DCE for interventional fluoroscopy procedures. Results There is very wide variation in the reported values of PKA, E, and DCE in the literature. A number of factors are involved in this variability and the resultant uncertainty in average values of these dose quantities. Conclusions The values of PKA, average E and suggested DCE presented here can be of use for comparison of the radiation detriment from different procedures and may be useful for categorizing detriment within an order of magnitude or so. They do not represent actual or expected radiation dose or detriment from any specific procedure or for a specific patient and should be not be used as such.

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Radiation Dose Exposure for Lumbar Spine Epidural Steroid Injections: A Comparison of Conventional Fluoroscopy Data and CT Fluoroscopy Techniques

Cited by 58 publications

References 13 publications

MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison

MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison

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

Review of air kerma‐area product, effective dose and dose conversion coefficients for non‐cardiac interventional fluoroscopy procedures

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