Radiation Exposure to the Hand of a Spinal Interventionalist during Fluoroscopically Guided Procedures

Yamashita, Kazuo; Ikuma, Hisanori; Tokashiki, Takuya; Maehara, Takashi; Nagamachi, Akihiro; Takata, Yoichiro; Sakai, Toshinori; Higashino, Kosaku; Sairyo, Koichi

doi:10.4184/asj.2017.11.1.75

Cited by 9 publications

(8 citation statements)

References 22 publications

(18 reference statements)

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“…Thus, CNRB can be performed more safely under ultrasound guidance than fluoroscopic guidance. At 2 weeks and 12 weeks after the procedure, no significant differences were found in terms of pain relief with underlying nerve block and ultrasound-guided CNRB; nevertheless, reports revealed that, under ultrasound guidance, it is possible to avoid inadvertent puncture (5/55 cases under fluoroscopy and 0/55 cases under ultrasonography), with no additional radiation exposure 4,13,14) .…”

Section: Discussionmentioning

confidence: 96%

Vascular Evaluation around the Cervical Nerve Roots during Ultrasound-Guided Cervical Nerve Root Block

Murata

Iwasaki

Natsumi³

et al. 2020

Spine Surg Relat Res

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Introduction: To carry out ultrasound-guided cervical nerve root block (CNRB) safely, we investigated the frequency of risky blood vessels around the target nerve root and within the imaginary needle pathway in the actual injecting position. Methods: 30 patients (20 men, 10 women) with cervical radiculopathy who received ultrasound-guided CNRB were included in this study. We defined a risky blood vessel as an artery existing within 4 mm from the center of the target nerve root or located in the range of 2 mm above or below the imaginary needle pathway. Results: Using the color Doppler method, the frequency of a risky blood vessel existing around 4 mm from the center of the C5 nerve root was 3.3% (1/30), whereas it was 3.3% (1/30) for the C6 nerve root and 23.3% (7/30) for the C7 nerve root. Hence, the C7 level had more blood vessels close to the target nerve root compared to the C5 and C6 levels, but there was no significant difference (p = 0.0523). On the other hand, the frequency of a risky blood vessel existing within 2 mm above and below the imaginary needle pathway was 3.3% (1/30) for the C5 nerve root, whereas it was 3.3% (1/30) for the C6 nerve root and 10.0% (3/30) for the C7 nerve root. The C7 level had more blood vessels within the needle pathway compared to the C5 and C6 levels, but there was no significant difference (p = 0.301). Conclusions: To reduce the risk of unintended intravascular injections, more careful checking for the presence or absence of blood vessels at the C7 level using color Doppler is necessary.

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Section: Discussionmentioning

confidence: 96%

Vascular Evaluation around the Cervical Nerve Roots during Ultrasound-Guided Cervical Nerve Root Block

Murata

Iwasaki

Natsumi³

et al. 2020

Spine Surg Relat Res

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“…Although there are reports of reducing radiation exposure during PPS placement under fluoroscopy [ 16 , 17 , 18 , 19 , 20 ], direct radiation exposure to hands and fingers during surgery remains a major problem [ 21 , 22 , 23 , 24 , 25 ]. In this new procedure, the radiation exposure range is approached only during the insertion of preoperative K-wire into the outer edge of the pedicle.…”

Section: Discussionmentioning

confidence: 99%

“…Yamashita et al report in detail the amount of fluoroscopic radiation exposure during spinal examinations. It is noteworthy that the level of exposure encountered by the fingers near the exposure area is high (the total occupational radiation exposure doses received at the finger for a 3-month study period was 368 mSv) [ 21 , 22 ]. Bindal et al reported an average exposure time of 1.69 min per operative procedure, an average skin surface exposure of 59.5 mSv for patients irradiated with posteroanterior fluoroscopy, and an average exposure of 0.76 mSv for the surgeon’s dominant hand during fluoroscopy in MIS-TLIF [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Reduction in Radiation Exposure in Minimally Invasive Pedicle Screw Placement Using a Tubular Retractor: A Pilot Study

Oki¹,

Lefor

Nakamura³

et al. 2022

Tomography

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Background and Objectives: Percutaneous pedicle screw (PPS) placement is a minimally invasive spinal procedure that has been rapidly adopted over the last decade. However, PPS placement has elicited fear of increased radiation exposure from some surgeons, medical staff, and patients. This is because PPS placement is performed using a K-wire, and the operator must perform K-wire insertion into the pedicle under fluoroscopy. In order to prevent erroneous insertion, there are many occasions when direct insertion is required during radiation exposure, and the amount of radiation exposure to hands and fingers in particular increases. Although these problems are being addressed by navigation systems, these systems are still expensive and not widely available. Attempts have been made to address this situation using instrumentation commonly used in spinal surgery. First, it was considered to visualize anatomical bone markers using a tubular retractor and a microscope. In addition, the use of a self-drilling pin was adopted to locate the pedicle in a narrower field of view. Based on these considerations, a minimally invasive and highly accurate pedicle screw placement technique was developed while avoiding direct radiation exposure. This study evaluated radiation exposure and accuracy of pedicle screw placement using this new procedure in one-level, minimally invasive, transforaminal lumbar interbody fusion (MIS-TLIF). Materials and Methods: Data were collected retrospectively to review pedicle screw placement in single-level MIS TLIFs using a tubular retractor under a microscope. The total fluoroscopy time, radiation dose, and screw placement accuracy were reviewed. Extension of operating time was also evaluated. Results: Twenty-four patients underwent single-level MIS TLIFs, with placement of 96 pedicle screws. There were 15 females and 9 males, with an average age of 64.8 years and a mean body mass index of 25.5 kg/m2. The mean operating time was 201.8 min. The mean fluoroscopic time was 26.8 s. The mean radiation dose of the area dose product was 0.0706 mGy∗m2. The mean radiation dose of air kerma was 6.0 mGy. The mean radiation dose of the entrance skin dose was 11.31 mGy. Postoperative computed tomography scans demonstrated 93 pedicle screws confined to the pedicle (97%) and three pedicle screw breaches (3.2%; two lateral, one medial). A patient with screw deviation of the medial pedicle wall developed right-foot numbness necessitating reoperation. There were no complications after reoperation. The average added time with this combined procedure was 39 min (range 16–69 min) per patient. Conclusions: This novel pedicle screw insertion technique compares favorably with other reports in terms of radiation exposure reduction and accuracy and is also useful from the viewpoint of avoiding direct radiation exposure to hands and fingers. It is economical because it uses existing spinal surgical instrumentation.

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“…Long-term exposure to even low dose of radiation is now believed to have harmful effects, hence mitigating exposure to physicians performing interventional techniques is of utmost importance. 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].…”

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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Radiation Exposure to the Hand of a Spinal Interventionalist during Fluoroscopically Guided Procedures

Cited by 9 publications

References 22 publications

Vascular Evaluation around the Cervical Nerve Roots during Ultrasound-Guided Cervical Nerve Root Block

Vascular Evaluation around the Cervical Nerve Roots during Ultrasound-Guided Cervical Nerve Root Block

Reduction in Radiation Exposure in Minimally Invasive Pedicle Screw Placement Using a Tubular Retractor: A Pilot Study

Proposed Ionizing Radiation Doses of 3711 Fluoroscopy-Guided Epidural Injections

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