Korean Journal of Radiology

  • 제16권2호
  • /
  • Pages.357-362
  • /
  • 2015
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Comparison of Radiation Exposure during Fluoroscopy-Guided Transforaminal Epidural Steroid Injections at Different Vertebral Levels

  • Hwang, Yun Mi (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Min Hee (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Seon-Jeong (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sheen-Woo (Department of Radiology, Gachon University Gil Hospital) ;
  • Chung, Hye Won (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sang Hoon (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shin, Myung Jin (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2014.01.10
  • 심사 : 2014.11.29
  • 발행 : 2015.04.01
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To estimate and compare radiation exposure during transforaminal fluoroscopy-guided epidural steroid injection (TFESI) at different vertebral levels. Materials and Methods: Fluoroscopy-guided TFESI was performed in 181 patients. The patients were categorized into three groups according to the injected lumbosacral nerve level of L2-4, L5, or S1. Fluoroscopy time (FT) and dose area product (DAP) were recorded for all patients; correlations between FT and DAP were determined at each level, and both FT and DAP were compared between the different vertebral levels. Results: The numbers of patients who received ESI at L2-4, L5, and S1 were 29, 123, and 29. Mean FT was 44 seconds at L2-4, 33.5 seconds at L5, and 37.7 seconds at S1. Mean DAP was $138.6{\mu}Gy{\cdot}m^2$ at L2-4, $100.6{\mu}Gy{\cdot}m^2$ at L5, and $72.1{\mu}Gy{\cdot}m^2$ at S1. FT and DAP were positively correlated in each group (p values < 0.001). FT was significantly shorter at L5 than that at L2-4 (p = 0.004) but was not significantly different between S1 and L2-4 or L5 (p values = 0.286 and 0.532, respectively). DAP was significantly smaller at L5 and S1 than that at L2-4, but L5 and S1 were not significantly different. After correcting for FT, DAP was significantly smaller at S1 than that at either L2-4 or L5 (p values = 0.001 and 0.010). Conclusion: The radiation dose was small during a single procedure of ESI and showed differences between different lumbosacral spine levels.

키워드

참고문헌

  1. Stout A. Epidural steroid injections for low back pain. Phys Med Rehabil Clin N Am 2010;21:825-834 https://doi.org/10.1016/j.pmr.2010.08.001
  2. Fink GE. Radiation safety in fluoroscopy for neuraxial injections. AANA J 2009;77:265-269
  3. Riew KD, Yin Y, Gilula L, Bridwell KH, Lenke LG, Lauryssen C, et al. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. J Bone Joint Surg Am 2000;82-A:1589-1593
  4. Friedly J, Chan L, Deyo R. Geographic variation in epidural steroid injection use in medicare patients. J Bone Joint Surg Am 2008;90:1730-1737 https://doi.org/10.2106/JBJS.G.00858
  5. Hoang JK, Yoshizumi TT, Toncheva G, Gray L, Gafton AR, Huh BK, et al. Radiation dose exposure for lumbar spine epidural steroid injections: a comparison of conventional fluoroscopy data and CT fluoroscopy techniques. AJR Am J Roentgenol 2011;197:778-782 https://doi.org/10.2214/AJR.10.6102
  6. Zhou Y, Singh N, Abdi S, Wu J, Crawford J, Furgang FA. Fluoroscopy radiation safety for spine interventional pain procedures in university teaching hospitals. Pain Physician 2005;8:49-53
  7. Hanu-Cernat DE, Duarte R, Raphael JH, Mutagi H, Kapur S, Senthil L. Type of interventional pain procedure, body weight, and presence of spinal pathology are determinants of the level of radiation exposure for fluoroscopically guided pain procedures. Pain Pract 2012;12:434-439 https://doi.org/10.1111/j.1533-2500.2011.00521.x
  8. Miller DL, Balter S, Schueler BA, Wagner LK, Strauss KJ, Vano E. Clinical radiation management for fluoroscopically guided interventional procedures. Radiology 2010;257:321-332 https://doi.org/10.1148/radiol.10091269
  9. Fletcher DW, Miller DL, Balter S, Taylor MA. Comparison of four techniques to estimate radiation dose to skin during angiographic and interventional radiology procedures. J Vasc Interv Radiol 2002;13:391-397 https://doi.org/10.1016/S1051-0443(07)61742-4
  10. Axelsson B. Optimisation in fluoroscopy. Biomed Imaging Interv J 2007;3:e47
  11. Hirshfeld JW Jr, Balter S, Brinker JA, Kern MJ, Klein LW, Lindsay BD, et al. ACCF/AHA/HRS/SCAI clinical competence statement on physician knowledge to optimize patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. Circulation 2005;111:511-532 https://doi.org/10.1161/01.CIR.0000157946.29224.5D
  12. Miller DL, Kwon D, Bonavia GH. Reference levels for patient radiation doses in interventional radiology: proposed initial values for U.S. practice. Radiology 2009;253:753-764 https://doi.org/10.1148/radiol.2533090354
  13. Stecker MS, Balter S, Towbin RB, Miller DL, Vano E, Bartal G, et al. Guidelines for patient radiation dose management. J Vasc Interv Radiol 2009;20(7 Suppl):S263-S273 https://doi.org/10.1016/j.jvir.2009.04.037
  14. Manchikanti L, Cash KA, Moss TL, Rivera J, Pampati V. Risk of whole body radiation exposure and protective measures in fluoroscopically guided interventional techniques: a prospective evaluation. BMC Anesthesiol 2003;3:2 https://doi.org/10.1186/1471-2253-3-2
  15. Fish DE, Lee PC, Marcus DB. The S1 "Scotty dog": report of a technique for S1 transforaminal epidural steroid injection. Arch Phys Med Rehabil 2007;88:1730-1733 https://doi.org/10.1016/j.apmr.2007.07.041
  16. Schueler BA. The AAPM/RSNA physics tutorial for residents: general overview of fluoroscopic imaging. Radiographics 2000;20:1115-1126 https://doi.org/10.1148/radiographics.20.4.g00jl301115

피인용 문헌

  1. Examining the association of body mass index and the depth of epidural space, radiation dose exposure and fluoroscopic screening time during transforaminal nerve block injection: a retrospective cohor vol.188, pp.1, 2019, https://doi.org/10.1007/s11845-018-1845-7
  2. A study on legal and medical dimensions of radiation exposure in neurosurgery clinics in Turkish practice vol.11, pp.None, 2015, https://doi.org/10.25259/sni_703_2020