Radiation Exposure of Fluoroscopic Guidance during Cervical Epidural Steroid Injection: A prospective study

Abstract

Backgroud and Purpose: To compare the radiation dose during cervical epidural steroid injection (ESI) under continuous and intermittent fluoroscopic guidance (FG), and to assess the radiation dose according to the three radiologists with different level of experiences. Material and Methods: IRB approval and informed consent were obtained for this study. Total 231 patients (M:F= 107:124

mean age, 50.3 years) who underwent 233 cervical ESIs from July 2011 to October 2011 were prospectively investigated. The radiation dose using dose area product (DAP) and fluoroscopy time (FT) was compared between continuous and intermittent FG for a senior professor. Among three radiologists (senior professor, junior professor, trainee), radiation dose of ESI under continuous FG were also compared. Mann-Whitney U test and ANOVA test were used for the statistical analysis. Results: Radiation dose under intermittent FG was significantly lower than under continuous FG in terms of DAP (1084.9 vs 506.4 mGy•cm2 for interlaminar ESI, and 2423.1 vs 799.7 mGy•cm2 for transforaminal ESI, p < 0.05) and in terms of FT (60.7 vs 25.2 sec in interlaminar ESI, and 119.9 vs 80.6 sec in transforaminal ESI, p-value < 0.05). Among the three operators, trainee showed highest radiation dose, but the calculated dose was within tolerable limit (0.65mSv of effective dose). Conclusion: Intermittent FG is preferable method to continuous FG during cervical ESI in the perspective of radiation exposures, but cervical ESI under continuous FG was within the tolerable limit even performed by the trainee.