title: Trends in Fluoroscopy Time in Fluoroscopy-Guided Lumbar Punctures Performed by Trainees Over an Academic Year.
abstract: Fluoroscopy-guided lumbar puncture (FGLP) is an operator-dependent procedure that can contribute to lifetime cumulative radiation dose. Benchmark fluoroscopic times (FTs) have been published for ranges of body mass index (BMI), but trends in FT in FGLPs performed by neuroradiology trainees during their training have not been studied. The purpose of this study was to investigate the trends in FTs in FGLPs performed by neuroradiology fellows in an academic year.
  
  
  
  We retrospectively reviewed FGLPs performed at our institution from July 2013 to June 2015 and determined the FT average and standard deviation of residents and non-neuroradiology fellows, neuroradiology fellows, and neuroradiology attendings. We used the Kruskal-Wallis test to evaluate group differences in FT in operator groups and academic quarters and by patient age, BMI, and needle length. Linear and Poisson regression analyses were performed to directly examine the relationship between the number of FGLPs performed and FTs.
  
  
  
  A total of 776 patients had successful FGLPs; 594 cases (77%) were performed by neuroradiology fellows (n = 14). The average FT and variance for neuroradiology fellows significantly decreased over the year (P = 0.004 and P < 0.001) with an estimated decrease of 0.01 minute of FT per FGLP. BMI, long needle length, and age ≥65 years old significantly affected the average FT (P = 0.03, P < 0.001, and P < 0.001) and FT decreased in all of these subgroups in the academic year.
  
  
  
  FT in FGLP cases performed by neuroradiology fellows decreases during the year. Our data can be utilized by radiology training programs and practices as a benchmark to monitor individual operator FT.
authors.affiliation: Department of Radiology, University Hospitals/Cleveland Medical Center, 11100 Euclid Avenue Mailstop BSH5056, Cleveland, OH 44106. Electronic address: ameya.nayate@uhhospitals.org.
authors.forename: Ameya P
authors.initials: AP
authors.lastname: Nayate
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: James E
authors.initials: JE
authors.lastname: Schmitt
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Suyash
authors.initials: S
authors.lastname: Mohan
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Ilya M
authors.initials: IM
authors.lastname: Nasrallah
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005257:Fellowships and Scholarships; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000706:statistics & numerical data*; D011871:Radiology / Q000193:education*; D012189:Retrospective Studies; D013129:Spinal Puncture / Q000706:statistics & numerical data*; D013997:Time Factors
keywords: fluoroscopy time; fluoroscopy-guided lumbar puncture; trainee performance