Lowering Radiation Publicity in Lumbar Transforaminal Epidural Steroid Injections with Pulsed Fluoroscopy: A Randomized, Double-blind, Managed Medical Trial.
Ache Doctor. 2018 Jan;21(1):53-60
Authors: Braun E, Sack AM, Sayed D, Manion S, Hamm B, Brimacombe M, Tollette M, Khan TW, Orr W, Nicol A
BACKGROUND: Fluoroscopy-guided lumbar transforaminal epidural steroid injections (L-TFESI) end in radiation publicity that carries dangers to sufferers, physicians, and procedural employees.
OBJECTIVE: We purpose to judge the feasibility of utilizing pulsed fluoroscopy to soundly scale back radiation publicity throughout L-TFESI.
STUDY DESIGN: It is a potential, double-blind, randomized managed trial.
SETTING: This research came about in a single-center, educational, outpatient interventional ache administration clinic.
METHODS: Sufferers present process L-TFESI have been randomly assigned to both steady mode fluoroscopy (high-dose), pulsed fluoroscopy with eight pulses per second (medium-dose), or pulsed fluoroscopy with one pulse per second (low-dose). Information on radiation doses and different scientific and demographic elements have been additionally collected.
RESULTS: In complete, 231 instances have been analyzed within the high-dose group (n = 81), medium-dose group (n = 72), and low-dose group (n = 78). Imply radiation efficient dose (µSv) was 121 within the high-dose group, 57.9 within the medium-dose group, and 34.eight within the low-dose group (P < zero.001). The incidence of insufficient picture high quality within the pulsed teams was 6% (9/150). The physique mass index (BMI, imply ± SD) was considerably greater in sufferers with insufficient picture high quality (37.three ± 7.2) than with satisfactory high quality (30.5 ± 7.2, P = zero.005).
LIMITATIONS: Radiation doses have been measured utilizing the meter on C-arm fluoroscopes reasonably than by direct measurement.
CONCLUSIONS: Using pulsed fluoroscopy throughout L-TFESI resulted in radiation dose discount of as much as 72.1% with out inflicting any vital hostile occasions. Pulsed fluoroscopy must be thought of as an preliminary fluoroscopic setting for L-TFESI to scale back radiation publicity.
KEY WORDS: Radiation, epidural, fluoroscopy, injection, publicity, pulse.
PMID: 29357331 [PubMed – in process]