Radiation exposure for fluoroscopy-guided lumbosacral epidural steroid injections: comparison of the transforaminal and caudal approaches.
METHODS
A retrospective investigation.


OBJECTIVE
We evaluated and compared the radiation exposure caused by using the fluoroscopy-guided transforaminal and caudal approaches of lumbosacral epidural steroid injection (ESI).


BACKGROUND
Only a few studies focused on the radiation exposure to patients who underwent lumbosacral ESI for pain management.


METHODS
A total of 228 patients (83 males, 145 females; mean age, 63.3 y) who received lumbosacral ESI were included. Transforaminal ESI was performed in 181 patients (67 males, 114 females; mean age, 61.3 y) and caudal ESI was used in 47 patients (16 males, 31 females; mean age, 69.7 y). All ESIs were performed under a single-plane fluoroscopic guidance by 1 musculoskeletal radiologist. The kerma-area product (KAP) and fluoroscopy time were recorded in all patients. Both measurements were correlated and compared for each approach.


RESULTS
KAP was 3.02-1048.2 μGy m (mean, 101.7 μGy m; median, 67.8 μGy m) for transforaminal ESI and 16.0-604.5 μGy m (mean, 101.8 μGy m; median, 54.6 μGy m) for caudal ESI. The fluoroscopy time was 11-161 seconds for transforaminal ESI (mean, 36.0 s; median, 29 s) and 4-78 seconds (mean, 18.2 s; median, 13 s) for caudal ESI. KAP and fluoroscopy time were positively correlated for each approach (P<0.001). Fluoroscopy time was significantly longer for transforaminal ESI (correlation coefficient=-0.77, P=0.000). After correction for the fluoroscopy time, KAP was less in transforaminal ESI than in caudal ESI (correlation coefficient=0.74, P=0.000).


CONCLUSIONS
The longer the fluoroscopy time, the greater the KAP in both transforaminal and caudal ESIs. The fluoroscopy time for transforaminal ESI was longer than that for caudal ESI. However, KAP of transforaminal ESI was less than that of the caudal ESI, after being corrected for the length of fluoroscopy time.
*Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul †Department of Radiology, Inje University Haeundae Paik Hospital, Busan ‡Department of Radiology, Gachon University Gil Hospital, Incheon, South Korea.
Seon-Jeong
SJ
Kim
Min Hee
MH
Lee
Sheen-Woo
SW
Lee
Hye Won
HW
Chung
Sang Hoon
SH
Lee
Myung Jin
MJ
Shin
D000368:Aged; D000763:Anesthesia, Caudal / Q000379:methods*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects*; D006801:Humans; D007268:Injections, Epidural; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000188:drug therapy; D008161:Lumbosacral Region / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012585:Sciatica / Q000000981:diagnostic imaging; D013256:Steroids / Q000008:administration & dosage* / Q000627:therapeutic use; D013997:Time Factors
D013256:Steroids