From the Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland (T.J.D., C.K.P., S.B., R.S., C.W.A.P.); Division of Medical Physics, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (K.G.Z.); and Faculty of Medicine, University of Zurich, Zurich, Switzerland (T.J.D., C.K.P., K.G.Z., S.B., R.S., C.W.A.P.).
Radiology. 2019 Mar;290(3):752-759. doi: 10.1148/radiol.2018181224. Epub 2019 Jan 8.
Purpose To compare the radiation exposure for participants and interventionalists as well as participant outcomes between fluoroscopy-guided versus CT-guided lumbar spinal injections. Materials and Methods This prospective, nonrandomized observational study included 1446 participants (mean age, 60.6 years; range, 18-91 years) who received transforaminal epidural injections or facet joint injections under fluoroscopic or CT guidance between October 2009 and April 2016. Effective doses were estimated by conversion from dose-area product for fluoroscopy-guided injections and dose-length product for CT-guided injections. Radiation exposure for interventionalists was measured with dosimeters at the body and wrist. The Patient Global Impression of Change (PGIC) scale was used to assess clinical participant outcomes at 1 day, 1 week, and 1 month after lumbar spine injections. Student t and χ tests were used for statistical analysis. Results The mean effective participant dose for fluoroscopy-guided lumbar transforaminal epidural injections was 0.24 mSv ± 0.22, compared with 0.33 mSv ± 0.10 for CT-guided injections (P < .003). The mean effective participant dose for fluoroscopy-guided lumbar facet joint injections was 0.10 mSv ± 0.11, compared with 0.33 mSv ± 0.13 for CT-guided injections (P < .001). Radiation exposure for the interventionalist was higher during fluoroscopy-guided compared with CT-guided lumbar transforaminal epidural injections (body: 0.42 × 10 mSv ± 0.99 vs 0.11 × 10 mSv ± 0.44, P < .03; wrist: 1.44 × 10 mSv ± 2.69 vs 0.14 × 10 mSv ± 0.55, P < .001). Radiation exposure of the wrist for the interventionalist was higher during fluoroscopy-guided compared with CT-guided lumbar facet injections (0.46 × 10 mSv ± 0.93 vs 0.06 × 10 mSv ± 0.24, respectively; P < .006). Clinical participant outcomes as determined with the PGIC scale did not differ between fluoroscopy-guided and CT-guided injections (P = .15-.96). Conclusion Radiation exposure in fluoroscopy-guided lumbar spinal injections was lower for participants and higher for physicians when compared with CT-guided injections; however, no associations were observed between clinical participant outcomes and type of imaging-guided injection technique at all evaluated time points. © RSNA, 2019.
目的 比较透视引导与 CT 引导下腰椎脊柱注射的参与者和介入放射医师的辐射暴露情况以及参与者的结局。
材料与方法 本前瞻性、非随机观察性研究纳入了 1446 名参与者（平均年龄 60.6 岁；范围 18-91 岁），他们在 2009 年 10 月至 2016 年 4 月期间分别接受了透视引导下经椎间孔硬膜外注射或关节突关节注射。透视引导下注射的有效剂量通过剂量-面积乘积换算，CT 引导下注射的有效剂量通过剂量-长度乘积换算。使用剂量计在身体和手腕处测量介入放射医师的辐射暴露。使用患者总体印象变化量表（PGIC）在腰椎注射后 1 天、1 周和 1 个月评估临床参与者的结局。使用 Student t 检验和 χ 检验进行统计学分析。
结果 透视引导下腰椎经椎间孔硬膜外注射的平均有效参与者剂量为 0.24 mSv ± 0.22，而 CT 引导下注射的平均有效参与者剂量为 0.33 mSv ± 0.10（P <.003）。透视引导下腰椎关节突关节注射的平均有效参与者剂量为 0.10 mSv ± 0.11，而 CT 引导下注射的平均有效参与者剂量为 0.33 mSv ± 0.13（P <.001）。与 CT 引导下腰椎经椎间孔硬膜外注射相比，透视引导下注射时介入放射医师的辐射暴露更高（身体：0.42×10 mSv ± 0.99 比 0.11×10 mSv ± 0.44，P <.03；手腕：1.44×10 mSv ± 2.69 比 0.14×10 mSv ± 0.55，P <.001）。与 CT 引导下腰椎关节突关节注射相比，透视引导下注射时介入放射医师手腕的辐射暴露更高（0.46×10 mSv ± 0.93 比 0.06×10 mSv ± 0.24，P <.006）。使用 PGIC 量表评估的临床参与者结局在透视引导下和 CT 引导下注射之间没有差异（P =.15-.96）。
结论 与 CT 引导下注射相比，透视引导下腰椎脊柱注射的参与者的辐射暴露较低，而医生的辐射暴露较高；然而，在所有评估的时间点，均未观察到临床参与者结局与影像学引导注射技术类型之间存在关联。
