Maino Paolo, Presilla Stefano, Colli Franzone Paola A, van Kuijk Sander M J, Perez Roberto S G M, Koetsier Eva
Pain Management Center, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland.
Medical Physics Unit, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland.
Pain Pract. 2018 Jul;18(6):798-804. doi: 10.1111/papr.12677. Epub 2018 Feb 5.
Transforaminal epidural steroid injections (TFESIs) and facet joint blocks can be performed under fluoroscopy or computed tomography (CT) guidance. The purpose of this retrospective cohort study was to compare patient radiation dose for lumbar TFESIs and facet joint blocks under CT guidance vs. fluoroscopic guidance.
The primary outcome of this retrospective cohort study was the difference between the estimated effective dose (ED) of CT guidance and fluoroscopic guidance for TFESIs and facet joint blocks. Patients who had undergone these procedures with both CT and fluoroscopic guidance were eligible for this study. Dose-length product for CT-guided procedures and dose-area product for fluoroscopic-guided procedures were retrospectively collected and converted to ED. Within- or between-group comparisons were performed with appropriate nonparametric tests, using a P value of < 0.05 to indicate statistical significance.
The 42 patients included in this study underwent a total of 100 procedures. The median estimated ED differed significantly between CT-guided injections and fluoroscopic-guided injections (1.59 mSv (interquartile range [IQR] 0.78 to 3.09) vs. 0.19 mSv (IQR 0.11 to 0.30) (Wilcoxon signed rank test, P < 0.001).
The study results suggest that TFESIs and facet joint blocks performed with CT guidance are associated with more than 8 times higher patient radiation dose exposure compared to fluoroscopic guidance. There needs to be more vigilance with regards to CT guidance in interventional pain procedures.
经椎间孔硬膜外类固醇注射（TFESI）和小关节阻滞可在荧光透视或计算机断层扫描（CT）引导下进行。这项回顾性队列研究的目的是比较在CT引导与荧光透视引导下进行腰椎TFESI和小关节阻滞时患者的辐射剂量。
这项回顾性队列研究的主要结局是CT引导与荧光透视引导下TFESI和小关节阻滞的估计有效剂量（ED）之间的差异。接受过CT和荧光透视引导下这些操作的患者符合本研究条件。回顾性收集CT引导操作的剂量长度乘积和荧光透视引导操作的剂量面积乘积，并将其转换为ED。使用适当的非参数检验进行组内或组间比较，P值<0.05表示具有统计学意义。
本研究纳入的42例患者共接受了100次操作。CT引导注射与荧光透视引导注射之间的估计ED中位数存在显著差异（1.59 mSv（四分位间距[IQR] 0.78至3.09） vs. 0.19 mSv（IQR 0.11至0.30）（Wilcoxon符号秩检验，P<0.001）。
研究结果表明，与荧光透视引导相比，CT引导下进行的TFESI和小关节阻滞使患者辐射剂量暴露高出8倍多。在介入性疼痛治疗中，对于CT引导需要更加警惕。
