title: Reduction in average fluoroscopic exposure times for interventional spinal procedures through the use of pulsed and low-dose image settings.
abstract: OBJECTIVE
  A practice improvement project was completed with the goal of reducing radiation exposure times in a busy spinal intervention practice through the use of "pulsed" and "low-dose fluoroscopy." The goal was to quantify the reduction in fluoroscopy exposure times with these modes.
  
  
  METHODS
  Exposure times were recorded for 316 patients undergoing spinal interventional procedures before and after the implementation of this project. Before implementation, 158 consecutive patients received spinal interventions with nonpulsed fluoroscopy on an Orthopedic Equipment Company 9800 and exposure times were recorded. After implementation of the practice improvement project, 158 consecutive patients received spinal interventions with pulsed and low-dose modes. Exposure times were then compared between these groups.
  
  
  RESULTS
  Pulsed and low-dose fluoroscopy modes reduced overall exposure times by 56.7% after implementation of the practice improvement project.
  
  
  CONCLUSIONS
  The use of pulsed and low-dose fluoroscopy in addition to lead shielding; increasing distance from the radiation source; collimation; limited use of magnification, boost, or digital subtraction; and proficiency with interventional techniques should be used to reduce radiation exposure in concordance with the principle of "as low as reasonably achievable."
authors.affiliation: Alabama Orthopedic, Spine & Sports Medicine Associates, Birmingham, AL, USA.
authors.forename: Bradly S
authors.initials: BS
authors.lastname: Goodman
authors.forename: Charles T
authors.initials: CT
authors.lastname: Carnel
authors.forename: Srinivas
authors.initials: S
authors.lastname: Mallempati
authors.forename: Pooja
authors.initials: P
authors.lastname: Agarwal
mesh_terms: D055011:Ablation Techniques; D001340:Autonomic Nerve Block; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D007278:Injections, Spinal; D008159:Lumbar Vertebrae / Q000601:surgery; D058996:Quality Improvement; D011829:Radiation Dosage; D015641:Radiography, Interventional; D013997:Time Factors; D021801:Zygapophyseal Joint / Q000601:surgery