Radiation Dose Exposure for Lumbar Transforaminal Epidural Steroid Injections and Facet Joint Blocks Under <scp>CT</scp> vs. Fluoroscopic Guidance

Maino, Paolo; Presilla, Stefano; Franzone, Paola A. Colli; Kuijk, Sander M. J. van; Pérez, Roberto; Koetsier, Eva

doi:10.1111/papr.12677

Cited by 17 publications

(11 citation statements)

References 28 publications

(31 reference statements)

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“…any patients with radicular pain due to nerve root compression or low back pain related to degeneration of the facet joint respond favorably to imaging-guided spinal therapeutic injections with steroids (1)(2)(3). Lumbar transforaminal epidural and lumbar facet joint steroid injections can be performed reliably, safely, and quickly with either a fluoroscopy-guided or CT-guided technique (4)(5)(6).…”

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confidence: 99%

Fluoroscopy-guided versus CT-guided Lumbar Steroid Injections: Comparison of Radiation Exposure and Outcomes

et al. 2019

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Purpose To compare the radiation exposure for participants and interventionalists as well as participant outcomes between fluoroscopy-guided versus CT-guided lumbar spinal injections. Materials and Methods This prospective, nonrandomized observational study included 1446 participants (mean age, 60.6 years; range, 18-91 years) who received transforaminal epidural injections or facet joint injections under fluoroscopic or CT guidance between October 2009 and April 2016. Effective doses were estimated by conversion from dose-area product for fluoroscopy-guided injections and dose-length product for CTguided injections. Radiation exposure for interventionalists was measured with dosimeters at the body and wrist. The Patient Global Impression of Change (PGIC) scale was used to assess clinical participant outcomes at 1 day, 1 week, and 1 month after lumbar spine injections. Student t and tests were used for statistical analysis. Results The mean effective participant dose for fluoroscopy-guided lumbar transforaminal epidural injections was 0.24 mSv ± 0.22, compared with 0.33 mSv ± 0.10 for CT-guided injections (P < .003). The mean effective participant dose for fluoroscopy-guided lumbar facet joint injections was 0.10 mSv ± 0.11, compared with 0.33 mSv ± 0.13 for CT-guided injections (P < .001). Radiation exposure for the interventionalist was higher during fluoroscopy-guided compared with CTguided lumbar transforaminal epidural injections (body: 0.42 × 10 mSv ± 0.99 vs 0.11 × 10 mSv ± 0.44, P < .03; wrist: 1.44 × 10 mSv ± 2.69 vs 0.14 × 10 mSv ± 0.55, P < .001). Radiation exposure of the wrist for the interventionalist was higher during fluoroscopy-guided compared with CT-guided lumbar facet injections (0.46 × 10 mSv ± 0.93 vs 0.06 × 10 mSv ± 0.24, respectively; P < .006). Clinical participant outcomes as determined with the PGIC scale did not differ between fluoroscopy-guided and CT-guided injections (P = .15-.96). Conclusion Radiation exposure in fluoroscopy-guided lumbar spinal injections was lower for participants and higher for physicians when compared with CT-guided injections; however, no associations were observed between clinical participant outcomes and type of imaging-guided injection technique at all evaluated time points.

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confidence: 99%

Fluoroscopy-guided versus CT-guided Lumbar Steroid Injections: Comparison of Radiation Exposure and Outcomes

et al. 2019

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“…Wearing lead aprons, maximizing the distance from the radioactive source, minimizing exposure time, avoiding magnification and increasing use of collimation are the main strategies to reduce radiation exposure with respect to ALARA principle [3,12] Aforementioned recommendations are often oversight; besides, physicians need reference level standards to assure quality controls. There is paucity of data regarding reference dose standards for epidural injections and available research have been focused on comparing radiation exposure for computed tomography or fluoroscopy-guided injections or conducted with relatively small sample sizes without available reference levels [13][14][15]. Our study is inspired by the paper of Cohen et al, which assessed 6.234 spinal injections and provided reference radiation doses for eleven different interventional procedures.…”

Section: Discussionmentioning

confidence: 99%

Proposed Ionizing Radiation Doses of 3711 Fluoroscopy-Guided Epidural Injections

Sacaklidir

Öztürk

Şencan

et al. 2021

Preprint

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Background: Since fluoroscopy-guided interventional therapies grew significantly in recent years, exposure to ionizing radiation (IR) either for patient or medical staff became a critical issue. IR exposure varies according to the physicians’ experience, patients’ body mass index (BMI), imaging techniques and type of the procedure performed. The purpose of this study is to calculate the reference IR doses for fluoroscopy-guided epidural injections per procedure and BMI to provide reference doses for potential use in future dose reduction strategies. Methods: A retrospectively, evaluation of patients who received epidural steroid injections between January 2015 and December 2020 in a university hospital interventional pain management center, was performed. This observational study was conducted with patients aged  18 who underwent 3711 epidural injections including cervical interlaminar, lumbar interlaminar, lumbar transforaminal and caudal approaches. Provided IR doses for each patient were also divided by patients’ BMI to obtain dose per BMI. Results: The highest IR dose per procedure was found in caudal epidural injection with 0.218 mGy m2 and lowest dose was in cervical interlaminar epidural injection with 0.057 mGy m2. The IR dose per procedure was 0.123 mGy m2 for lumbar transforaminal and 0.191 mGy m2 for lumbar interlaminar epidural injection. Caudal epidural injection had also the highest IR dose per BMI which was 0.00749 and cervical interlaminar epidural injection had the lowest radiation dose per BMI which was 0.00214. Conclusions: We proposed reference IR dose levels of four approaches of epidural injections obtained from 3711 injections performed in a university hospital pain medicine clinic. BMI of patients were taken into account with the dose levels of injections given per BMI. Multicenter research with standardized techniques will assure more reliable reference levels which will guide pain physicians to self-assess their own levels of radiation exposure.

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“…In the current work, the extra-guidance technique using the Xper CT reflected a better efficacy with a moderate increase of irradiation hazards (2 folds increase in ED). The implication of CT as a guidance tool has been used for interventional pain procedures, such as celiac plexus and lumbar sympathetic blocks [36, 37]. It allows better visualization of the whole needle path, surrounding soft tissues, and vascular and bony structures [38].…”

Section: Discussionmentioning

confidence: 99%

“…It allows better visualization of the whole needle path, surrounding soft tissues, and vascular and bony structures [38]. However, CT-associated exposure to excessive irradiation may induce carcinogenesis, genetic mutation and several other hazards [37, 38]. In previous studies conducted by Hoang et al [39] and Schmid et al [40] comparing irradiation dose during pain interventions guided by fluoroscopy versus CT, Hoang et al reported 4 times more radiation exposure during CT than fluoroscopy [39].…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies conducted by Hoang et al [39] and Schmid et al [40] comparing irradiation dose during pain interventions guided by fluoroscopy versus CT, Hoang et al reported 4 times more radiation exposure during CT than fluoroscopy [39]. In recent work published by Maino et al [37] in 2018, the ED for lumbar facetal and transforaminal injections was calculated to be 8 to 10 times higher under CT versus fluoroscopy. The lower ED in the current study (2 folds) could be attributed to Xper CT guide technique for fast and accurate RF needle positioning.…”

Section: Discussionmentioning

confidence: 99%

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Modified technique for thermal radiofrequency ablation of Thoracic dorsal root ganglia under combined fluoroscopy and CT guidance: a randomized clinical trial

et al. 2019

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BackgroundThis study is comparing thermal radiofrequency ablation (TRFA) of the thoracic dorsal root ganglia (TDRG) guided by Xper CT and fluoroscopy with the standard fluoroscopy.MethodsThis randomized clinical trial included 78 patients suffering from chronic refractory pain due to chest malignancies randomly allocated into one of two groups according to guidance of TRFA of TDRG. In CT guided group (n = 40) TRFA was done under integrated Xper CT-scan and fluoroscopy guidance, while it was done under fluoroscopy guidance only in standard group (n = 38). The primary outcome was pain intensity measured by visual analog scale (VAS) score, functional improvement and consumption of analgesics. The secondary outcome measures were patient global impression of changes (PGIC) and adverse effects.ResultsVAS scores decreased in the two groups compared to baseline values (p < 0.001) and were lower in CT guided group up to 12 weeks. Pregabalin and oxycodone consumption was higher in the standard group at 1, 4 and 12 weeks (p < 0.001). Functional improvement showed near significant difference between the two groups (P = 0.06 at week 1, 0.07 at week 4 respectively) while the difference was statistically significant at week 12 (P = 0.04). PGIC showed near significant difference only at week 1 (P = 0.07) while the per-patient adverse events were lower in CT guided group (p = 0.027).ConclusionsIntegrated modality guidance with Xper CT-scan and fluoroscopy together with suprapedicular inferior transforaminal approach may improve efficacy and safety of TRFA of TDRG for the treatment of intractable chest pain in cancer patients.Trial registrationThe study was retrospectively registered at clinicaltrials.gov on 04/22/2018 (Registration No.: NCT03533413).

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Radiation Dose Exposure for Lumbar Transforaminal Epidural Steroid Injections and Facet Joint Blocks Under CT vs. Fluoroscopic Guidance

Cited by 17 publications

References 28 publications

Fluoroscopy-guided versus CT-guided Lumbar Steroid Injections: Comparison of Radiation Exposure and Outcomes

Fluoroscopy-guided versus CT-guided Lumbar Steroid Injections: Comparison of Radiation Exposure and Outcomes

Proposed Ionizing Radiation Doses of 3711 Fluoroscopy-Guided Epidural Injections

Modified technique for thermal radiofrequency ablation of Thoracic dorsal root ganglia under combined fluoroscopy and CT guidance: a randomized clinical trial

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