Radiation dose exposure for lumbar spine epidural steroid injections: A comparison of conventional fluoroscopy data and CT fluoroscopy techniques

Jenny K. Hoang, Terry T. Yoshizumi, Greta Toncheva, Linda Gray, Andreia R. Gafton, Billy K. Huh, James D. Eastwood, Christopher D. Lascola, Lynne M. Hurwitz

Research output: Contribution to journalArticle

Abstract

OBJECTIVE. The purpose of this article is to compare the radiation dose of conventional fluoroscopy-guided lumbar epidural steroid injections (ESIs) and CT fluoroscopy (CTF)-guided lumbar ESI using both clinical data and anthropomorphic phantoms. MATERIALS AND METHODS. We performed a retrospective review of dose parameters for 14 conventional fluoroscopy ESI procedures performed by one proceduralist and 42 CTF-guided ESIs performed by three proceduralists (14 each). By use of imaging techniques similar to those for our clinical cohorts, a commercially available anthropomorphic male phantom with metal oxide semiconductor field effect transistor detectors was scanned to obtain absorbed organ doses for conventional fluoroscopy-guided and CTF-guided ESIs. Effective dose (ED) was calculated from measured organ doses. RESULTS. The mean conventional fluoroscopy time for ESI was 37 seconds, and the mean procedural CTF time was 4.7 seconds. Calculated ED for conventional fluoroscopy was 0.85 mSv compared with 0.45 mSv for CTF. The greatest contribution to the radiation dose from CTF-guided ESI came from the planning lumbar spine CT scan, which had an ED of 2.90 mSv when z-axis ranged from L2 to S1. This resulted in a total ED for CTF-guided ESI (lumbar spine CT scan plus CTF) of 3.35 mSv. CONCLUSION. The ED for the CTF-guided ESI was almost half that of conventional fluoroscopy because of the shorter fluoroscopy time. However, the overall radiation dose for CTF-guided ESIs can be up to four times higher when a full diagnostic lumbar CT scan is performed as part of the procedure. Radiation dose reduction for CTF-guided ESI is best achieved by minimizing the dose from the preliminary planning lumbar spine CT scan.

Original languageEnglish (US)
Pages (from-to)778-782
Number of pages5
JournalAmerican Journal of Roentgenology
Volume197
Issue number4
DOIs
StatePublished - Oct 1 2011
Externally publishedYes

Fingerprint

Epidural Injections
Fluoroscopy
Spine
Steroids
Radiation
Radiation Exposure
Semiconductors

Keywords

  • Conventional fluoroscopy
  • CT fluoroscopy
  • Lumbar epidural injection
  • Radiation dose
  • Spine intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Radiation dose exposure for lumbar spine epidural steroid injections : A comparison of conventional fluoroscopy data and CT fluoroscopy techniques. / Hoang, Jenny K.; Yoshizumi, Terry T.; Toncheva, Greta; Gray, Linda; Gafton, Andreia R.; Huh, Billy K.; Eastwood, James D.; Lascola, Christopher D.; Hurwitz, Lynne M.

In: American Journal of Roentgenology, Vol. 197, No. 4, 01.10.2011, p. 778-782.

Research output: Contribution to journalArticle

Hoang, Jenny K. ; Yoshizumi, Terry T. ; Toncheva, Greta ; Gray, Linda ; Gafton, Andreia R. ; Huh, Billy K. ; Eastwood, James D. ; Lascola, Christopher D. ; Hurwitz, Lynne M. / Radiation dose exposure for lumbar spine epidural steroid injections : A comparison of conventional fluoroscopy data and CT fluoroscopy techniques. In: American Journal of Roentgenology. 2011 ; Vol. 197, No. 4. pp. 778-782.
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T2 - A comparison of conventional fluoroscopy data and CT fluoroscopy techniques

AU - Hoang, Jenny K.

AU - Yoshizumi, Terry T.

AU - Toncheva, Greta

AU - Gray, Linda

AU - Gafton, Andreia R.

AU - Huh, Billy K.

AU - Eastwood, James D.

AU - Lascola, Christopher D.

AU - Hurwitz, Lynne M.

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N2 - OBJECTIVE. The purpose of this article is to compare the radiation dose of conventional fluoroscopy-guided lumbar epidural steroid injections (ESIs) and CT fluoroscopy (CTF)-guided lumbar ESI using both clinical data and anthropomorphic phantoms. MATERIALS AND METHODS. We performed a retrospective review of dose parameters for 14 conventional fluoroscopy ESI procedures performed by one proceduralist and 42 CTF-guided ESIs performed by three proceduralists (14 each). By use of imaging techniques similar to those for our clinical cohorts, a commercially available anthropomorphic male phantom with metal oxide semiconductor field effect transistor detectors was scanned to obtain absorbed organ doses for conventional fluoroscopy-guided and CTF-guided ESIs. Effective dose (ED) was calculated from measured organ doses. RESULTS. The mean conventional fluoroscopy time for ESI was 37 seconds, and the mean procedural CTF time was 4.7 seconds. Calculated ED for conventional fluoroscopy was 0.85 mSv compared with 0.45 mSv for CTF. The greatest contribution to the radiation dose from CTF-guided ESI came from the planning lumbar spine CT scan, which had an ED of 2.90 mSv when z-axis ranged from L2 to S1. This resulted in a total ED for CTF-guided ESI (lumbar spine CT scan plus CTF) of 3.35 mSv. CONCLUSION. The ED for the CTF-guided ESI was almost half that of conventional fluoroscopy because of the shorter fluoroscopy time. However, the overall radiation dose for CTF-guided ESIs can be up to four times higher when a full diagnostic lumbar CT scan is performed as part of the procedure. Radiation dose reduction for CTF-guided ESI is best achieved by minimizing the dose from the preliminary planning lumbar spine CT scan.

AB - OBJECTIVE. The purpose of this article is to compare the radiation dose of conventional fluoroscopy-guided lumbar epidural steroid injections (ESIs) and CT fluoroscopy (CTF)-guided lumbar ESI using both clinical data and anthropomorphic phantoms. MATERIALS AND METHODS. We performed a retrospective review of dose parameters for 14 conventional fluoroscopy ESI procedures performed by one proceduralist and 42 CTF-guided ESIs performed by three proceduralists (14 each). By use of imaging techniques similar to those for our clinical cohorts, a commercially available anthropomorphic male phantom with metal oxide semiconductor field effect transistor detectors was scanned to obtain absorbed organ doses for conventional fluoroscopy-guided and CTF-guided ESIs. Effective dose (ED) was calculated from measured organ doses. RESULTS. The mean conventional fluoroscopy time for ESI was 37 seconds, and the mean procedural CTF time was 4.7 seconds. Calculated ED for conventional fluoroscopy was 0.85 mSv compared with 0.45 mSv for CTF. The greatest contribution to the radiation dose from CTF-guided ESI came from the planning lumbar spine CT scan, which had an ED of 2.90 mSv when z-axis ranged from L2 to S1. This resulted in a total ED for CTF-guided ESI (lumbar spine CT scan plus CTF) of 3.35 mSv. CONCLUSION. The ED for the CTF-guided ESI was almost half that of conventional fluoroscopy because of the shorter fluoroscopy time. However, the overall radiation dose for CTF-guided ESIs can be up to four times higher when a full diagnostic lumbar CT scan is performed as part of the procedure. Radiation dose reduction for CTF-guided ESI is best achieved by minimizing the dose from the preliminary planning lumbar spine CT scan.

KW - Conventional fluoroscopy

KW - CT fluoroscopy

KW - Lumbar epidural injection

KW - Radiation dose

KW - Spine intervention

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