title: Risk of whole body radiation exposure and protective measures in fluoroscopically guided interventional techniques: a prospective evaluation.
abstract: BACKGROUND: Fluoroscopic guidance is frequently utilized in interventional pain management. The major purpose of fluoroscopy is correct needle placement to ensure target specificity and accurate delivery of the injectate. Radiation exposure may be associated with risks to physician, patient and personnel. While there have been many studies evaluating the risk of radiation exposure and techniques to reduce this risk in the upper part of the body, the literature is scant in evaluating the risk of radiation exposure in the lower part of the body. METHODS: Radiation exposure risk to the physician was evaluated in 1156 patients undergoing interventional procedures under fluoroscopy by 3 physicians. Monitoring of scattered radiation exposure in the upper and lower body, inside and outside the lead apron was carried out. RESULTS: The average exposure per procedure was 12.0 PlusMinus; 9.8 seconds, 9.0 PlusMinus; 0.37 seconds, and 7.5 PlusMinus; 1.27 seconds in Groups I, II, and III respectively. Scatter radiation exposure ranged from a low of 3.7 PlusMinus; 0.29 seconds for caudal/interlaminar epidurals to 61.0 PlusMinus; 9.0 seconds for discography. Inside the apron, over the thyroid collar on the neck, the scatter radiation exposure was 68 mREM in Group I consisting of 201 patients who had a total of 330 procedures with an average of 0.2060 mREM per procedure and 25 mREM in Group II consisting of 446 patients who had a total of 662 procedures with average of 0.0378 mREM per procedure. The scatter radiation exposure was 0 mREM in Group III consisting of 509 patients who had a total 827 procedures. Increased levels of exposures were observed in Groups I and II compared to Group III, and Group I compared to Group II.Groin exposure showed 0 mREM exposure in Groups I and II and 15 mREM in Group III. Scatter radiation exposure for groin outside the apron in Group I was 1260 mREM and per procedure was 3.8182 mREM. In Group II the scatter radiation exposure was 400 mREM and with 0.6042 mREM per procedure. In Group III the scatter radiation exposure was 1152 mREM with 1.3930 mREM per procedure. CONCLUSION: Results of this study showed that scatter radiation exposure to both the upper and lower parts of the physician's body is present. Protection was offered by traditional measures to the upper body only.
authors.affiliation: Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, Kentucky, USA. drm@apex.net
authors.forename: Laxmaiah
authors.initials: L
authors.lastname: Manchikanti
authors.forename: Kim A
authors.initials: KA
authors.lastname: Cash
authors.forename: Tammy L
authors.initials: TL
authors.lastname: Moss
authors.forename: Jose
authors.initials: J
authors.lastname: Rivera
authors.forename: Vidyasagar
authors.initials: V
authors.lastname: Pampati