title: Effective dose of CT- and fluoroscopy-guided perineural/epidural injections of the lumbar spine: a comparative study.
abstract: The objective of this study was to compare the effective radiation dose of perineural and epidural injections of the lumbar spine under computed tomography (CT) or fluoroscopic guidance with respect to dose-reduced protocols. We assessed the radiation dose with an Alderson Rando phantom at the lumbar segment L4/5 using 29 thermoluminescence dosimeters. Based on our clinical experience, 4-10 CT scans and 1-min fluoroscopy are appropriate. Effective doses were calculated for CT for a routine lumbar spine protocol and for maximum dose reduction; as well as for fluoroscopy in a continuous and a pulsed mode (3-15 pulses/s). Effective doses under CT guidance were 1.51 mSv for 4 scans and 3.53 mSv for 10 scans using a standard protocol and 0.22 mSv and 0.43 mSv for the low-dose protocol. In continuous mode, the effective doses ranged from 0.43 to 1.25 mSv for 1-3 min of fluoroscopy. Using 1 min of pulsed fluoroscopy, the effective dose was less than 0.1 mSv for 3 pulses/s. A consequent low-dose CT protocol reduces the effective dose compared to a standard lumbar spine protocol by more than 85%. The latter dose might be expected when applying about 1 min of continuous fluoroscopy for guidance. A pulsed mode further reduces the effective dose of fluoroscopy by 80-90%.
authors.affiliation: Department of Radiology and Nuclear Medicine, Johanna-Etienne-Krankenhaus, Neuss, Germany. G.Schmid@jek-neuss.de
authors.forename: Gebhard
authors.initials: G
authors.lastname: Schmid
authors.forename: Alexander
authors.initials: A
authors.lastname: Schmitz
authors.forename: Dieter
authors.initials: D
authors.lastname: Borchardt
authors.forename: Klaus
authors.initials: K
authors.lastname: Ewen
authors.forename: Thomas
authors.initials: T
authors.lastname: von Rothenburg
authors.forename: Odo
authors.initials: O
authors.lastname: Koester
authors.forename: Michael
authors.initials: M
authors.lastname: Jergas
mesh_terms: D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007268:Injections, Epidural; D007278:Injections, Spinal; D017116:Low Back Pain / Q000188:drug therapy*; D008159:Lumbar Vertebrae; D008297:Male; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D015641:Radiography, Interventional; D013819:Thermoluminescent Dosimetry; D014057:Tomography, X-Ray Computed