Radiation exposure in fluoroscopy guided spinal interventions: A prospective observational study of standard practice in a physiatry academic center.

CONTEXT

Fluoroscopy is the recommended image guidance modality for most spinal pain interventions. However, it exposes interventional pain physicians to chronic ionizing radiation, with known risks to the eye, skin, and hand. The use of protective glasses and gloves is variable among pain physicians.

OBJECTIVES

To document the total radiation exposure (mSv) by pain physicians to their eyes, hands and chest in an academic setting including various spinal interventions.

METHODS

Four pain physicians wore a finger, head/collar (equivalent to eye exposure) and chest dosimeter over and under their lead apron during a three-month period where they performed their usual fluoroscopy-guided interventions, including close supervision of trainees. We calculated an average exposure per intervention and extrapolated the recorded exposure to a maximum, worst-case scenario of a caseload of 13 procedures per day, 5 days a week and 52 weeks per year.

RESULTS

Four pain physicians of variable experience performed 15 different types of procedures on 607 patients throughout the study period. The yearly maximum exposure scenarios for each pain physician were all below the Canadian Nuclear Safety Commission thresholds for nuclear energy workers: for the hands (31.56 mSv, 25.67 mSv, 20.59 mSv, 21.51 mSv; threshold = 500 mSv), eyes (16.01 mSv, 18.64 mSv, 24.08 mSv, 18.68 mSv; threshold = 50 mSv) and chest over the lead apron (28.27 mSv, 46.91 mSv, 30.00 mSv, 40,03 mSv; whole body threshold = 50 mSv), with some doses even below general population thresholds. The exposure under the lead apron was 0 mSv for each pain physician.

CONCLUSION

The standard practice of an interventional pain physician using fluoroscopy in this academic setting is below radiation exposure regulations, even in a theoretical, worst-case, maximum exposure scenario. Standard radiation protection practices such as the use of lead aprons and thyroid shields should still be used. However, this data is reassuring for pain physicians with a practice in fluoroscopy-guided interventions who wish to not use protective glasses or gloves.