title: Is There a Relationship Between Body Mass Index and Fluoroscopy Time During Cervical Interlaminar Epidural Steroid Injections?
abstract: BACKGROUND
  The challenge of obtaining medical imaging in individuals with higher body mass index (BMI) is described, but there is minimal data regarding the relationship between BMI and fluoroscopy time during cervical interlaminar epidural steroid injection (CIESI).
  
  
  OBJECTIVE
  To determine the relationship between BMI and fluoroscopy time during CIESI.
  
  
  METHODS
  Retrospective cohort study of patients who underwent fluoroscopically guided CIESI between January 2014 and February 2015 at an academic pain medicine center. Fluoroscopy time data were collected. Comparisons based on analysis of variance were made between patients with normal (<25.0 kg/m 2 ), overweight (25.0-29.9 kg/m 2 ), and obese (≥30.0 kg/m 2 ) BMI.
  
  
  RESULTS
  Of 399 procedure encounters, 366 had documented BMI and fluoroscopy time data and were included for analysis. Mean age (± SD) in this cohort was 53 ± 13 years, including 189 females (52%) and 205 first-time injections. Mean fluoroscopy time for all injections was 18 ± 10 seconds. Separated by categorical BMI class, the mean fluoroscopy time was 18 ± 9 seconds for normal weight patients, 17 ± 10 seconds for overweight patients, and 20 ± 11 seconds for obese patients, respectively. Post hoc analysis showed that fluoroscopy time was significantly longer only in obese compared with overweight patients ( P  = 0.02). Trainee involvement and first-time vs repeat injection did not significantly alter fluoroscopy time ( P  = 0.17 and P  = 0.12, respectively).
  
  
  CONCLUSIONS
  The findings of this study indicate that BMI does not appear to have a clinically significant impact on fluoroscopy time during cervical interlaminar epidural steroid injection procedures. Future study is needed to directly quantify radiation exposure in patients and practitioners, as well as the associated health risk.
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Zachary L
authors.initials: ZL
authors.lastname: McCormick
authors.affiliation: Department of Orthopaedic Surgery, Stanford University, Palo Alto, California.
authors.forename: Ryan
authors.initials: R
authors.lastname: Mattie
authors.affiliation: Department of Anesthesia, Northwestern Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Ali
authors.initials: A
authors.lastname: Ebrahimi
authors.affiliation: Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David T
authors.initials: DT
authors.lastname: Lee
authors.affiliation: Midwestern University, Downers Grove, Illinois.
authors.forename: Austin
authors.initials: A
authors.lastname: Marcolina
authors.affiliation: Department of Physical Medicine and Rehabilitation, the Rehabilitation Institute of Chicago, Chicago, Illinois.
authors.forename: Joel
authors.initials: J
authors.lastname: Press
authors.affiliation: Department of Orthopaedic Surgery, Stanford University, Palo Alto, California.
authors.forename: D J
authors.initials: DJ
authors.lastname: Kennedy
authors.affiliation: Department of Orthopaedic Surgery, Stanford University, Palo Alto, California.
authors.forename: Matthew
authors.initials: M
authors.lastname: Smuck
authors.affiliation: Department of Anesthesia, Northwestern Feinberg School of Medicine, Chicago, Illinois.
authors.forename: David R
authors.initials: DR
authors.lastname: Walega
authors.affiliation: Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cushman
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D005260:Female; D005471:Fluoroscopy / Q000639:trends*; D006801:Humans; D007268:Injections, Epidural; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000000981:diagnostic imaging* / Q000188:drug therapy; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage*; D013997:Time Factors
chemical_list: D013256:Steroids
keywords: Body Mass Index; Cervical Epidural Steroid; Fluoroscopy; Injections; Obesity; Overweight; Radiation