Decreased patient exposure to ionizing radiation during interventional rheumatology procedures after optimization of protection.
OBJECTIVE
To decrease radiation exposure of patients undergoing interventional rheumatology procedures, without adversely affecting quality of care.


METHODS
The radiation dose received, assessed by the dose-area product (DAP), was measured during 283 intraarticular injections performed under fluoroscopic guidance between May and July 2013. Then, three steps were taken to decrease patients' radiation exposure: a copper filter was added, the anti-scatter grid was removed, and exposure cell sensitivity was set at the highest value. DAP was measured during 158 intraarticular injections performed in 2014 with these measures in place.


RESULTS
Mean DAP before optimization was 175μGray·m2during facet joint injections (n=4) and 43μGray·m2during hip injections but was less than 20μGray·m2for injections into the shoulders (15.7μGray·m2), ankles (7.7μGray·m2), wrists (3.7μGray·m2), and fingers (3.3μGray·m2). After optimization, DAP decreased markedly for all injection sites, by 52% (shoulders) to 87% (facet joints, 22.7μGray·m2). Decreases occurred at all three steps of the procedure, i.e., patient installation, injection, and last image hold. Exposure during facet joint injections varied from 84 (54.5-108.5) μGray·m2when body mass index (BMI) was <25kg/m2to 228.9 (161.3-340.4)μGray·m2when BMI was>30kg/m2.


CONCLUSIONS
Simple technical changes translate into large decreases in patient radiation exposure during fluoroscopically-guided injections, particularly at the facet joints and in obese patients.
Service de rhumatologie, CHD Vendée, boulevard Stéphane-Moreau, 85925 La Roche-sur-Yon cedex 9, France.
Céline
C
Cozic
Unité de physique médicale, CHD Vendée, 85925 La Roche-sur-Yon cedex 9, France.
Fabien
F
Audran
Service de radiologie, CHD Vendée, 85925 La Roche-sur-Yon cedex 9, France.
Christophe
C
Blanchard
Unité de radioprotection, CHD Vendée, 85925 La Roche-sur-Yon cedex 9, France.
Christophe
C
David
Service de rhumatologie, CHD Vendée, boulevard Stéphane-Moreau, 85925 La Roche-sur-Yon cedex 9, France.
Vincent
V
Andre
Service de rhumatologie, CHD Vendée, boulevard Stéphane-Moreau, 85925 La Roche-sur-Yon cedex 9, France.
Michel
M
Caulier
Service de rhumatologie, CHD Vendée, boulevard Stéphane-Moreau, 85925 La Roche-sur-Yon cedex 9, France.
Stéphane
S
Varin
Service de rhumatologie, CHD Vendée, boulevard Stéphane-Moreau, 85925 La Roche-sur-Yon cedex 9, France.
Gilles
G
Tanguy
Service de recherche clinique, CHD Vendée, 85925 La Roche-sur-Yon cedex 9, France.
Jérôme
J
Dimet
Service de rhumatologie, CHD Vendée, boulevard Stéphane-Moreau, 85925 La Roche-sur-Yon cedex 9, France. Electronic address: gregoire.cormier@chd-vendee.fr.
Grégoire
G
Cormier
D005471:Fluoroscopy / Q000009:adverse effects*; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods*; D050177:Overweight; D011787:Quality of Health Care; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects*; D011835:Radiation Protection; D011839:Radiation, Ionizing; D015641:Radiography, Interventional / Q000009:adverse effects*
Interventional rheumatology; Optimization of protection; Patient radiation exposure; Radioprotection