Radiation exposure of the spinal interventionalist performing fluoroscopically guided lumbar transforaminal epidural steroid injections.
OBJECTIVE
To evaluate radiation exposure to spinal interventionalists while performing transforaminal epidural steroid injections (TFESIs).


METHODS
Prospective study.


METHODS
Multidisciplinary spine center.


METHODS
One hundred consecutive patients with either herniated nucleus pulposus (HNP) or lumbar spinal stenosis (LSS).


METHODS
Fluroscopically guided lumbar TFESIs.


METHODS
Radiation exposure was monitored by radiography technologists who allocated 4 dosimetry badges to all spinal interventionalists performing fluroscopically guided lumbar TFESIs on patients being treated for radicular pain. Badges were placed on the ring finger, glasses, and the inside and outside of the lead apron worn by the interventionalists. The radiography technologists also wore marked badges outside their lead aprons. One control badge was placed 67in away from the fluoroscopy table and a second badge was placed in a desk more than 500ft away from the procedure to monitor ambient radiation.


RESULTS
The average fluoroscopy time per procedure was 15.16 seconds. The average exposure per procedure was 0.7mrem at the ring badge, 0.4mrem at the glasses badge, and 0.3mrem at the outside apron badge. No radiation was detectable at the inside apron or at the outside room control badge. The cumulative exposure to the interventionalists from all 100 procedures was 70mrem at the ring badge, 40mrem at the glasses badge, and 30mrem at the outside apron badge. The radiography technologists' average exposure during these procedures was below the limit of detectablility. Radiation time under fluoroscopy ranged from 5 to 38 seconds. The interventionalist's exposure to radiation was significantly greater during procedures conducted on patients with LSS then during procedures on patients with HNP.


CONCLUSIONS
Adhering to a radiation safety program that includes maximizing the distance the spinal interventionalist is from the radiation source, decreasing exposure time, and proper shielding is essential when performing fluoroscopically guided lumbar TFESIs. Our study shows that exposure to radiation of the spinal interventionalist performing fluoroscopically guided lumbar TFESIs was well within safety limits when proper techniques were followed.
Botwin
Kenneth P
KP
Florida Spine Institute, Clearwater, FL 33765, USA.
Thomas
Santhosh
S
Gruber
Robert D
RD
Torres
Francisco M
FM
Bouchlas
Constantine C
CC
Rittenberg
Joshua J
JJ
Rao
Sanjiv
S
D000368:Aged; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007268:Injections, Epidural; D017116:Low Back Pain / Q000000981:diagnostic imaging*; D008297:Male; D008503:Medical Staff; D008875:Middle Aged; D009437:Neuralgia / Q000000981:diagnostic imaging*; D016272:Occupational Health; D011446:Prospective Studies; D011829:Radiation Dosage; D015641:Radiography, Interventional; D013256:Steroids / Q000008:administration & dosage*; D013997:Time Factors
D013256:Steroids