Nayate Ameya P, Schmitt James E, Mohan Suyash, Nasrallah Ilya M
Department of Radiology, University Hospitals/Cleveland Medical Center, 11100 Euclid Avenue Mailstop BSH5056, Cleveland, OH 44106.
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Acad Radiol. 2017 Mar;24(3):373-380. doi: 10.1016/j.acra.2016.11.004. Epub 2017 Jan 16.
Fluoroscopy-guided lumbar puncture (FGLP) is an operator-dependent procedure that can contribute to lifetime cumulative radiation dose. Benchmark fluoroscopic times (FTs) have been published for ranges of body mass index (BMI), but trends in FT in FGLPs performed by neuroradiology trainees during their training have not been studied. The purpose of this study was to investigate the trends in FTs in FGLPs performed by neuroradiology fellows in an academic year.
We retrospectively reviewed FGLPs performed at our institution from July 2013 to June 2015 and determined the FT average and standard deviation of residents and non-neuroradiology fellows, neuroradiology fellows, and neuroradiology attendings. We used the Kruskal-Wallis test to evaluate group differences in FT in operator groups and academic quarters and by patient age, BMI, and needle length. Linear and Poisson regression analyses were performed to directly examine the relationship between the number of FGLPs performed and FTs.
A total of 776 patients had successful FGLPs; 594 cases (77%) were performed by neuroradiology fellows (n = 14). The average FT and variance for neuroradiology fellows significantly decreased over the year (P = 0.004 and P < 0.001) with an estimated decrease of 0.01 minute of FT per FGLP. BMI, long needle length, and age ≥65 years old significantly affected the average FT (P = 0.03, P < 0.001, and P < 0.001) and FT decreased in all of these subgroups in the academic year.
FT in FGLP cases performed by neuroradiology fellows decreases during the year. Our data can be utilized by radiology training programs and practices as a benchmark to monitor individual operator FT.
透视引导下腰椎穿刺（FGLP）是一种依赖操作者的操作，可能会增加终生累积辐射剂量。已公布了不同体重指数（BMI）范围的透视基准时间（FT），但神经放射科住院医师在培训期间进行FGLP的FT趋势尚未得到研究。本研究的目的是调查神经放射科住院医师在一学年内进行FGLP的FT趋势。
我们回顾性分析了2013年7月至2015年6月在我院进行的FGLP，确定了住院医师、非神经放射科住院医师、神经放射科住院医师和神经放射科主治医师的FT平均值和标准差。我们使用Kruskal-Wallis检验来评估操作者组、学年季度以及患者年龄、BMI和针长对FT的组间差异。进行线性和泊松回归分析以直接检验FGLP操作次数与FT之间的关系。
共有776例患者成功进行了FGLP；594例（77%）由神经放射科住院医师（n = 14）完成。神经放射科住院医师的平均FT和方差在这一年中显著下降（P = 0.004和P < 0.001），估计每进行一次FGLP的FT减少0.01分钟。BMI、长针长度和年龄≥65岁显著影响平均FT（P = 0.03、P < 0.001和P < 0.001），并且在这一学年中所有这些亚组的FT均下降。
神经放射科住院医师进行的FGLP病例的FT在这一年中有所下降。我们的数据可被放射科培训项目和实践用作监测个体操作者FT的基准。
