University of Kansas Medical Center, Kansas City, KS.
Pain Physician. 2018 Jan;21(1):53-60.
Fluoroscopy-guided lumbar transforaminal epidural steroid injections (L-TFESI) result in radiation exposure that carries risks to patients, physicians, and procedural staff.
We aim to evaluate the feasibility of using pulsed fluoroscopy to safely reduce radiation exposure during L-TFESI.
This is a prospective, double-blind, randomized controlled trial.
This study took place in a single-center, academic, outpatient interventional pain management clinic.
Patients undergoing L-TFESI were randomly assigned to either continuous mode fluoroscopy (high-dose), pulsed fluoroscopy with 8 pulses per second (medium-dose), or pulsed fluoroscopy with one pulse per second (low-dose). Data on radiation doses and other clinical and demographic factors were also collected.
In total, 231 cases were analyzed in the high-dose group (n = 81), medium-dose group (n = 72), and low-dose group (n = 78). Mean radiation effective dose (µSv) was 121 in the high-dose group, 57.9 in the medium-dose group, and 34.8 in the low-dose group (P < 0.001). The incidence of inadequate image quality in the pulsed groups was 6% (9/150). The body mass index (BMI, mean ± SD) was significantly higher in patients with inadequate image quality (37.3 ± 7.2) than with adequate quality (30.5 ± 7.2, P = 0.005).
Radiation doses were measured using the meter on C-arm fluoroscopes rather than by direct measurement.
The use of pulsed fluoroscopy during L-TFESI resulted in radiation dose reduction of up to 72.1% without causing any significant adverse events. Pulsed fluoroscopy should be considered as an initial fluoroscopic setting for L-TFESI to reduce radiation exposure.
Radiation, epidural, fluoroscopy, injection, exposure, pulse.
荧光透视引导下的腰椎经椎间孔硬膜外类固醇注射（L-TFESI）会导致患者、医生和操作程序人员受到辐射，从而带来风险。
我们旨在评估使用脉冲荧光透视术安全降低 L-TFESI 过程中辐射暴露的可行性。
这是一项前瞻性、双盲、随机对照试验。
本研究在单中心、学术性、门诊介入性疼痛管理诊所进行。
接受 L-TFESI 的患者被随机分配至连续模式荧光透视（高剂量组）、每秒 8 脉冲的脉冲荧光透视（中剂量组）或每秒 1 脉冲的脉冲荧光透视（低剂量组）。还收集了有关辐射剂量和其他临床及人口统计学因素的数据。
在高剂量组（n = 81）、中剂量组（n = 72）和低剂量组（n = 78）中，共分析了 231 例病例。高剂量组的平均有效辐射剂量（µSv）为 121，中剂量组为 57.9，低剂量组为 34.8（P < 0.001）。脉冲组中图像质量不足的发生率为 6%（9/150）。图像质量不足的患者的体重指数（BMI，平均值 ± 标准差）明显高于图像质量良好的患者（37.3 ± 7.2 与 30.5 ± 7.2，P = 0.005）。
辐射剂量是使用 C 臂荧光透视仪上的仪表测量的，而不是直接测量的。
在 L-TFESI 过程中使用脉冲荧光透视术可将辐射剂量降低多达 72.1%，而不会引起任何显著的不良事件。脉冲荧光透视术应被视为 L-TFESI 初始荧光透视设置，以降低辐射暴露。
辐射，硬膜外，荧光透视，注射，暴露，脉冲。
