title: Periradicular infiltration of the lumbar spine: testing the robustness of an interventional ultra-low-dose protocol at different body mass index levels.
abstract: Background Computed tomography (CT)-guided periradicular infiltration remains a frequent interventional procedure for treatment of low back pain. Purpose To present an interventional ultra-low-dose protocol for CT-guided periradicular infiltration therapy and assess its application at different body mass index (BMI) levels. Material and Methods Over a period of 14 months, 79 patients underwent 183 CT-guided interventions for single-site lumbar periradicular therapy using an ultra-low-dose protocol with a basic setup of 100 kV and 5 mAs. Procedures were performed via intermittent fluoroscopy. A retrospective review was performed to analyze the parameters tube current and tube voltage, dose-length product, and BMI. Results The interventional ultra-low-dose protocol allowed safe treatment of 91.1% of the patients without a need for adapting the protocol. In seven patients with a higher BMI (range, 31-38 kg/m2; mean, 34 kg/m2), the tube current had to be increased to retain sufficient image quality. Only patients with a BMI of 30 and higher showed a significant correlation between BMI and dose-length product ( P value = 0.02), resulting in a slightly increased dose ( P value = 0.002). Conclusion The protocol presented for the interventional part of CT-guided periradicular infiltration allows to safely treat patients with a median calculated effective dose of 0.045 mSv (converted from a dose-length-product of 2.26 mGy*cm). Patients with a BMI of 30 and higher required a higher calculated effective dose with just one patient slightly exceeding 0.1 mSv.
authors.affiliation: Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Fabian Henry Jürgen
authors.initials: FHJ
authors.lastname: Elsholtz
authors.affiliation: Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Lars-Arne
authors.initials: LA
authors.lastname: Schaafs
authors.affiliation: Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Köhlitz
authors.affiliation: Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
authors.affiliation: Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Stefan Markus
authors.initials: SM
authors.lastname: Niehues
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D015992:Body Mass Index; D003348:Cortisone / Q000008:administration & dosage*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D003348:Cortisone
keywords: Interventional radiology; computed tomography (CT); injection; lumbar; radiation dosage; spine