title: Radiation dose exposure for lumbar spine epidural steroid injections: a comparison of conventional fluoroscopy data and CT fluoroscopy techniques.
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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710, USA. jennykh@gmail.com
authors.forename: Jenny K
authors.initials: JK
authors.lastname: Hoang
authors.forename: Terry T
authors.initials: TT
authors.lastname: Yoshizumi
authors.forename: Greta
authors.initials: G
authors.lastname: Toncheva
authors.forename: Linda
authors.initials: L
authors.lastname: Gray
authors.forename: Andreia R
authors.initials: AR
authors.lastname: Gafton
authors.forename: Billy K
authors.initials: BK
authors.lastname: Huh
authors.forename: James D
authors.initials: JD
authors.lastname: Eastwood
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Lascola
authors.forename: Lynne M
authors.initials: LM
authors.lastname: Hurwitz
mesh_terms: D000368:Aged; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; 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 / Q000379:methods*; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D013256:Steroids