Background: Since fluoroscopy-guided interventional therapies grew
significantly in recent years, exposure to ionizing radiation (IR)
either for patient or medical staff became a critical issue. IR exposure
varies according to the physicians’ experience, patients’ body mass
index (BMI), imaging techniques and type of the procedure performed. The
purpose of this study is to calculate the reference IR doses for
fluoroscopy-guided epidural injections per procedure and BMI to provide
reference doses for potential use in future dose reduction strategies.
Methods: A retrospectively, evaluation of patients who received epidural
steroid injections between January 2015 and December 2020 in a
university hospital interventional pain management center, was
performed. This observational study was conducted with patients aged
18 who underwent 3711 epidural injections including cervical
interlaminar, lumbar interlaminar, lumbar transforaminal and caudal
approaches. Provided IR doses for each patient were also divided by
patients’ BMI to obtain dose per BMI. Results: The highest IR dose per
procedure was found in caudal epidural injection with 0.218 mGy m2 and
lowest dose was in cervical interlaminar epidural injection with 0.057
mGy m2. The IR dose per procedure was 0.123 mGy m2 for lumbar
transforaminal and 0.191 mGy m2 for lumbar interlaminar epidural
injection. Caudal epidural injection had also the highest IR dose per
BMI which was 0.00749 and cervical interlaminar epidural injection had
the lowest radiation dose per BMI which was 0.00214. Conclusions: We
proposed reference IR dose levels of four approaches of epidural
injections obtained from 3711 injections performed in a university
hospital pain medicine clinic. BMI of patients were taken into account
with the dose levels of injections given per BMI. Multicenter research
with standardized techniques will assure more reliable reference levels
which will guide pain physicians to self-assess their own levels of
radiation exposure.
Proposed Ionizing Radiation Doses of 3711 Fluoroscopy-Guided Epidural Injections
