Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Marmara University, ?stanbul, Turkey.
Pain Physician. 2022 Jan;25(1):E67-E72.
Although fluoroscopy-guided interventional therapies have declined in recent years, radiation exposure remains a critical issue for both patients and medical staff. Radiation exposure varies according to the physicians' experience, procedure time, patients' body mass index (BMI), imaging techniques, and the type of procedure performed.
The purpose of this study is to report procedure times and calculate the radiation doses for 4 different approaches of fluoroscopy-guided epidural injections per procedure and BMI to provide radiations doses for potential use in future dose reduction strategies.
Retrospective, observational study.
A university hospital, pain management center.
A retrospective evaluation was performed of patients who received epidural steroid injections between January 2015 and December 2020 in a university hospital interventional pain management center. This observational study was conducted with patients aged >= 18 who underwent 3,711 epidural injections including cervical interlaminar, lumbar interlaminar, lumbar transforaminal, and caudal approaches. If more than one level or bilateral injections were performed, total dose and times were divided by the number of sites injected to attain procedure time and mean dose per injection. Provided doses for each patient were also divided by patients' BMI to obtain dose per BMI.
The highest radiation dose per procedure was found in caudal epidural injection with 0.218 mGy·m2, and the lowest dose was found in cervical interlaminar epidural injection with 0.057 mGy·m2. The radiation dose per procedure was 0.123 mGy·m2 for lumbar transforaminal and 0.191 mGy·m2 for lumbar interlaminar epidural injection. The shortest procedure time was determined in transforaminal (37.3 seconds) injections, and the longest was in lumbar interlaminar (46.7 seconds) injections. Caudal epidural injection also had the highest radiation dose per BMI which was 0.00749, and cervical interlaminar epidural injection had the lowest radiation dose per BMI, which was 0.00214.
Firstly, injections were performed by first- or second-year fellows in pain medicine. Moreover, patient-related factors (previous surgery, scoliosis, etc.) affecting radiation exposure were ignored.
Radiation dose levels and procedure times of 4 approaches of epidural injections were obtained from 3,711 procedures performed in a university hospital pain medicine clinic. BMI of patients was taken into account with the dose levels of injections given per BMI. Multicenter research with standardized techniques will assure more reliable reference levels, which will guide pain physicians to self-assess their own levels of radiation exposure.
尽管近年来荧光透视引导的介入治疗有所减少，但辐射暴露仍然是患者和医务人员的一个关键问题。辐射暴露因医生的经验、手术时间、患者的体重指数（BMI）、成像技术和所进行的手术类型而异。
本研究的目的是报告每例手术的手术时间，并计算 4 种不同的荧光透视引导硬膜外注射方法的辐射剂量，以提供潜在用于未来剂量减少策略的辐射剂量。
回顾性、观察性研究。
一所大学医院，疼痛管理中心。
对 2015 年 1 月至 2020 年 12 月期间在一所大学医院介入性疼痛管理中心接受硬膜外类固醇注射的患者进行了回顾性评估。这项观察性研究纳入了年龄≥18 岁的患者，他们接受了 3711 次硬膜外注射，包括颈椎间、腰椎间、腰椎经椎间孔和骶管入路。如果进行了多个水平或双侧注射，则将总剂量和时间除以注射部位的数量，以获得手术时间和每注射剂量的平均剂量。还根据患者的 BMI 对每位患者的剂量进行了划分，以获得每 BMI 的剂量。
发现单次手术的最高辐射剂量为骶管硬膜外注射，为 0.218 mGy·m2，最低剂量为颈椎间硬膜外注射，为 0.057 mGy·m2。单次手术的辐射剂量为腰椎经椎间孔 0.123 mGy·m2，腰椎间 0.191 mGy·m2。经椎间孔注射的手术时间最短（37.3 秒），腰椎间注射的手术时间最长（46.7 秒）。骶管硬膜外注射的 BMI 辐射剂量最高，为 0.00749，颈椎间硬膜外注射的 BMI 辐射剂量最低，为 0.00214。
首先，注射由疼痛医学的第一年或第二年研究员进行。此外，忽略了影响辐射暴露的与患者相关的因素（如既往手术、脊柱侧弯等）。
从一所大学医院疼痛医学诊所进行的 3711 例手术中获得了 4 种硬膜外注射方法的辐射剂量水平和手术时间。考虑了患者的 BMI，并按每 BMI 给予的注射剂量计算了剂量水平。采用标准化技术的多中心研究将确保更可靠的参考水平，这将指导疼痛医师评估自己的辐射暴露水平。
