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Effective Dose of CT- and Fluoroscopy-Guided Perineural/Epidural Injections of the Lumbar Spine: A Comparative Study

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Abstract

The objective of this study was to compare the effective radiation dose of perineural and epidural injections of the lumbar spine under computed tomography (CT) or fluoroscopic guidance with respect to dose-reduced protocols. We assessed the radiation dose with an Alderson Rando phantom at the lumbar segment L4/5 using 29 thermoluminescence dosimeters. Based on our clinical experience, 4–10 CT scans and 1-min fluoroscopy are appropriate. Effective doses were calculated for CT for a routine lumbar spine protocol and for maximum dose reduction; as well as for fluoroscopy in a continuous and a pulsed mode (3–15 pulses/s). Effective doses under CT guidance were 1.51 mSv for 4 scans and 3.53 mSv for 10 scans using a standard protocol and 0.22 mSv and 0.43 mSv for the low-dose protocol. In continuous mode, the effective doses ranged from 0.43 to 1.25 mSv for 1–3 min of fluoroscopy. Using 1 min of pulsed fluoroscopy, the effective dose was less than 0.1 mSv for 3 pulses/s. A consequent low-dose CT protocol reduces the effective dose compared to a standard lumbar spine protocol by more than 85%. The latter dose might be expected when applying about 1 min of continuous fluoroscopy for guidance. A pulsed mode further reduces the effective dose of fluoroscopy by 80–90%.

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References

  1. Johnson BA, Schellhas KP, Pollei SR (1999) Epidurography and therapeutic epidural injections: technical considerations and experience with 5334 cases. Am J Neuroradiol 20:697–705

    CAS  PubMed  Google Scholar 

  2. Gangi A, Dietemann JL, Mortazavi R, et al. (1998) CT-guided interventional procedures for pain management in the lumbosacral spine. RadioGraphics 18:621–633

    CAS  PubMed  Google Scholar 

  3. El-Khoury GY, Ehara S, Weinstein JN, et al. (1988) Epidural steroid injection: a procedure ideally performed with fluoroscopic control. Radiology 168:554–557

    CAS  PubMed  Google Scholar 

  4. Renfrew DL, Moore TE, Kathol MH, et al. (1991) Correct placement of epidural steroid injections: fluoroscopic guidance and contrast administration. Am J Neuroradiol 12(5):1003–1007

    CAS  PubMed  Google Scholar 

  5. Golding SJ, Shrimpton PC (2002) Radiation dose in CT: are we meeting the challenge? Br J Radiol 75:1–4

    CAS  PubMed  Google Scholar 

  6. Boland GW, Murphy B, Arellano R, et al. (2000) Dose reduction in gastrointestinal and genitourinary fluoroscopy: use of grid-controlled pulsed fluoroscopy. Am J Roentgenol 175(5):1453–1457

    CAS  Google Scholar 

  7. Huda W, Sandison GA (1984) Estimation of mean organ doses in diagnostic radiology from Rando Phantom measurments. Health Phys 47(3):463–467

    CAS  PubMed  Google Scholar 

  8. International Commission on Radiological Protection (1990) 1990 Recommendations of the International Commission on Radiological Protection. Pergamon. Oxford

    Google Scholar 

  9. Anon. (1976) Environmental radioactivity and radiation exposure. Annual Report. The Secretary of State for Home Affairs of Germany

  10. Evans W (1930) Intrasacral epidural injection therapy in the treatment of sciatica. Lancet 2:1225–1229

    Google Scholar 

  11. White AH, Derby R, Wynne G (1980) Epidural injections for the diagnosis and treatment of low back pain. Spine 5:78–86

    CAS  PubMed  Google Scholar 

  12. Zennaro H, Dousset V, Viaud B, et al. (1998) Periganglionic foraminal steroid injections performed under CT control. Am J Neuroradiol 19:349–352

    CAS  PubMed  Google Scholar 

  13. CT guided perineural injection technique. In: Kraemer J, Koester K (eds) MR Imaging of the Lumbar Spine. A Teaching Atlas. Thieme: New York, pp 18–26

  14. Carette S, Leclaire R, Marcoux S et al. (1997) Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 336:1634–1640

    Article  CAS  PubMed  Google Scholar 

  15. Schmid G, Vetter S, Göttmann D, et al. (1999) CT-guided epidural/perineural injections in painful disorders of the lumbar spine: short and extended-term results. Cardiovasc Intervent Radiol 22(6):493–498

    CAS  PubMed  Google Scholar 

  16. Becker CR, Schatzl M, Feist H, et al. (1998) Radiation exposure during CT examination of thorax and abdomen. Comparision of sequential, spiral and electron beam computed tomography. Radiologe 38(9):726–729

    Article  CAS  PubMed  Google Scholar 

  17. Van Unnik JG, Broerse JJ, Geleijns J, et al. (1997) Survey of CT techniques and absorbed dose in various Dutch hospitals. Br J Radiol 70(832):367–371

    PubMed  Google Scholar 

  18. Calzado A, Rodríguez R, Munoz A (2000) Quality criteria implementation for brain and lumbar spine CT examinations. Br J Radiol 73:384–395

    CAS  PubMed  Google Scholar 

  19. Galanski M, Nagel HD, Stamm G (2001) CT-Expositionspraxis in derBundesrepublik Deutschland: Ergebnisse einer bundesweiten Umfrage im Jahr 1999. Fortschr Röntgenstr 173:1–66

    Google Scholar 

  20. Geleijns J, Broerse JJ, Shaw MP, et al.(1997) Patient dose due to colon examination: dose assessment and results from a survey in The Netherlands. Radiology 204(2):553–559

    CAS  PubMed  Google Scholar 

  21. Scanavacca M, D´Avila A, Velarde JL, et al. (1998) Reduction of radiation exposure time during cathetzer ablation with the use of pulsed fluoroscopy. Int J Cardiol 63(1):71–74

    Article  CAS  PubMed  Google Scholar 

  22. Nicolic B, Spies JB, Campbell L, et al. (2001) Uterine artery embolization: reduced radiation with refined technique. J Vasc Intervent Radiol 12(1):39–44

    Google Scholar 

  23. Hernandez RJ, Goodsitt MM (1996) Reduction of radiation dose in pediatric patients using pulsed fluoroscopy. Am J Roentgenol 167:1247–1253

    CAS  Google Scholar 

  24. Vetter S, Heckmann H, Strecker EP, et al. (1998) Klinische Aspekte zu Bildqualität und Dosis bei gittergesteuerter gepulster Durchleuchtung. Akt Radiol 8:191–195

    CAS  Google Scholar 

  25. Andrews RT, Brown PH (2000) Uterine arterial embolization: factors influencing patient radiation exposure. Radiology 217(3):713–722

    CAS  PubMed  Google Scholar 

  26. Nicolic B, Abbara S, Levy E, et al. (2000) Influence of radiographic technique and equipment on absorbed ovarian dose associated with uterine artery embolization. J Vasc Intervent Radiol 11(9):1173–1178

    Google Scholar 

  27. McParland BJ (1998) A study of patient radiation doses in interventional radiological procedures. Br J Radiol 71(842):175–185

    CAS  PubMed  Google Scholar 

  28. Teeuwisse WM, Geleijns J, Broerse JJ, et al. (2001) Patient and staff dose during CT guided biopsy, drainage and coagulation. Br J Radiol 74(884):720–726

    CAS  PubMed  Google Scholar 

  29. Slomczykowski M, Roberto M, Schneeberger P, et al. (1999) Radiation dose for pedicle screw insertion. Fluoroscopic method versus computer-assisted surgery. Spine 24(10):975–982

    Article  CAS  PubMed  Google Scholar 

  30. Schaeren S, Roth J, Dick W (2002) Effective in vivo radiation dose with image reconstruction controlled pedicle instrumentation vs. CT-based navigation. Orthopade 31(4):392–396

    Article  CAS  PubMed  Google Scholar 

  31. Botwin KP, Thomas S, Torres FM, et al. (2002) Radiation exposure of the spinal interventionalist performing fluoroscopically guided lumbar transforaminal epidural steroid injections. Arch Phys Med Rehabil 83(5):697–701

    Article  PubMed  Google Scholar 

  32. Crawley MT, Rogers AT (2000) Dose–area product measurements in a range of common orthopaedic procedures and their possible use in establishing local diagnostic reference levels. Br J Radiol 73:740–744

    CAS  PubMed  Google Scholar 

  33. Buls N, Pages J, de Mey J, et al. (2003) Evaluation of patient and staff doses during various CT fluoroscopy guided interventions. Health Phys 85(2):165–73

    CAS  PubMed  Google Scholar 

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Correspondence to Gebhard Schmid.

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Schmid, G., Schmitz, A., Borchardt, D. et al. Effective Dose of CT- and Fluoroscopy-Guided Perineural/Epidural Injections of the Lumbar Spine: A Comparative Study. Cardiovasc Intervent Radiol 29, 84–91 (2006). https://doi.org/10.1007/s00270-004-0355-3

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  • DOI: https://doi.org/10.1007/s00270-004-0355-3

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