scholarly journals Computed Tomography Guidance for Spinal Intervention: Basics of Technique, Pearls, and Avoiding Pitfalls

2013 ◽  
Vol 4;16 (4;7) ◽  
pp. 369-377
Author(s):  
Dr. Vincent Timpone
Keyword(s):  
Computed Tomography ◽  
Radiation Dose ◽  
Image Guidance ◽  
Facet Joint ◽  
Ct Guidance ◽  
Success Rates ◽  
Advantages And Disadvantages ◽  
Computed Tomography Fluoroscopy ◽  
Anatomical Detail ◽  
Needle Trajectory

The utilization of spinal interventional pain techniques has grown rapidly over the last decade. However, practitioners use widely different techniques in these procedures, particularly in the use of image guidance. The importance of image guidance was highlighted by the fact that in recent systematic reviews on therapeutic effectiveness of epidural steroid injections and facet joint interventions, only studies that used image guidance were included. The choice of image guidance remains a matter of physician preference with conventional fluoroscopic or Computed Tomography (CT) guidance most common. There are many advantages to CT guidance for certain spinal interventional pain procedures, mainly due to increased needle tip positioning accuracy. CT guidance provides greater anatomical detail that facilitates accurate needle trajectory planning, monitoring and final placement. Unlike conventional fluoroscopy that may be hindered by tissue overlap and lack of surrounding anatomical detail CT guidance offers direct visualization of the entire needle trajectory and the surrounding soft tissue and bone structures. Large osteophytes and adjacent vascular structures can be identified and safely avoided. The goals of this narrative review are to provide a basic overview of CT techniques available for spinal interventional pain procedures, to discuss the potential advantages and disadvantages of CT guidance, to provide a simple step-by-step approach to use of CT guidance, to share technical pearls, and to discuss methods to avoid potential pitfalls. This review will provide interventional pain physicians with knowledge of relevant CT image acquisition techniques and appropriate radiation dose reduction strategies. This will contribute to increased technical success rates while reducing radiation dose to the patient and staff. Key words: Computed tomography, fluoroscopy, analgesia, epidural injection, spinal injection, back pain, safety

scholarly journals Comparison between Computed Tomography & Fluoroscopy Guided Facet Joint Block in Lumbar Spine

2013 ◽  
Vol 5 (1) ◽  
pp. 21-29
Author(s):  
Hassan Al-Shatoury ◽  
Mohammad Al-Shatouri ◽  
Samir Alghandour
Keyword(s):  
Computed Tomography ◽  
Lumbar Spine ◽  
Facet Joint ◽  
Computed Tomography Fluoroscopy

Imaging techniques for sacroiliac joint injections

2021 ◽  
pp. 115-120
Author(s):  
Jacqueline Weisbein
Keyword(s):  
Computed Tomography ◽  
Stem Cells ◽  
Sacroiliac Joint ◽  
Image Guidance ◽  
Platelet Rich Plasma ◽  
Imaging Techniques ◽  
Image Guided ◽  
Computed Tomography Fluoroscopy ◽  
Regenerative Therapies ◽  
Joint Injections

Injections into the sacroiliac joint for both diagnostic and therapeutic purposes have become commonplace. There have been advances in the use of regenerative therapies other than prolotherapy, such as platelet-rich plasma and stem cells. Prior to the introduction of image-guided techniques, blind injections were performed. However, data have consistently shown that without image guidance, injections failed to be accurately placed within the joint. Therefore, the use of image guidance, whether by computed tomography, fluoroscopy, or ultrasound, is imperative to ensure accurate placement of the injectate. This chapter discusses these three types of imaging techniques for sacroiliac joint injections.

Radiation Dose to the Eyes and Parotids during CT of the Sinuses

2005 ◽  
Vol 133 (4) ◽  
pp. 531-533 ◽  
Author(s):  
Marc K. Bassim ◽  
Charles S. Ebert ◽  
Roger C. Sit ◽  
Brent A. Senior
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Radiation Dose ◽  
Image Guidance ◽  
Preoperative Planning ◽  
Minimal Risk ◽  
Computed Tomography Scan ◽  
High Resolution Computed Tomography ◽  
Thermoluminescent Dosimeters ◽  
Tomography Scan

OBJECTIVE: To measure the radiation dose to the lens and parotid during high-resolution computed tomography scan of the sinuses. STUDY DESIGN AND SETTING: Nine cadaver heads were scanned in the axial plane by means of a fine-cut (0.75 mm) protocol. Images were then reconstructed in the coronal and sagittal planes for use with the image guidance software. Thermoluminescent dosimeters were taped over the eyes and parotids and used to measure the radiation dose absorbed by these organs. RESULTS: Doses obtained were 29.5 mGy for the lens and around 30 mGy for the parotid. CONCLUSION: The measured doses are lower than the reported acute thresholds of 500-2000 mGy for lens opacities and well below the threshold of 2500 mGy for damage to the parotid. SIGNIFICANCE: These results demonstrate minimal risk from radiation through the use of high-resolution computed tomography and support the use of such a protocol for diagnosis and preoperative planning.

Use of magnetic resonance venography for inferior petrosal sinus sampling

2021 ◽  
pp. 112972982199726
Author(s):  
Kikutaro Tokairin ◽  
Toshiya Osanai ◽  
Noriyuki Fujima ◽  
Kinya Ishizaka ◽  
Hiroaki Motegi ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Radiation Dose ◽  
Interventional Procedure ◽  
Anatomical Variations ◽  
Magnetic Resonance Venography ◽  
University Hospital ◽  
Inferior Petrosal Sinus ◽  
Success Rates ◽  
Intravenous Catheter ◽  
Patient Demographics

Background: Inferior petrosal sinus (IPS) sampling (IPSS) is a transvenous interventional procedure performed to diagnose Cushing’s disease. The reported IPSS failure rate is approximately 10% because IPS catheter delivery is conducted blindly and is challenging because of IPS anatomical variations. This study aimed to evaluate the usefulness of preprocedural magnetic resonance venography (MRV) for assessing IPS access routes before IPSS. Methods: Nineteen consecutive patients who underwent IPSS at a single university hospital in Japan were retrospectively studied. A preprocedural MRV protocol optimized to visualize the IPS before IPSS was established and utilized in the eight most recent cases. An IPSS procedure was considered successful when bilateral IPS catheterization was accomplished. Patient demographics, IPSS success rate, and radiation dose required during IPSS were compared between two groups: MRV group ( N = 8) and no-MRV group ( N = 11) before IPSS. Results: There were no significant differences in age, sex, and IPSS success rates between the groups. The average radiation dose was 663.6 ± 246.8 (SD) mGy and 981.7 ± 389.5 (SD) mGy in the MRV group and no-MRV group, respectively. Thus, there was a significant reduction in radiation exposure in the MRV group ( p = 0.044). Catheterization of the left IPS was unsuccessful in only one patient in the MRV group owing to IPS hypoplasty, as found on the MRV. Conclusions: Hypoplastic IPSs occur in patients and can complicate IPSS. Preprocedural MRV assessment is useful for understanding venous anatomy and preventing unnecessary intravenous catheter manipulation during IPSS, which involves blind manipulation around the IPS.

scholarly journals Radiation dose estimation for pencil beam X-ray luminescence computed tomography imaging

2021 ◽  
pp. 1-12
Author(s):  
Ignacio O. Romero ◽  
Changqing Li
Keyword(s):  
Computed Tomography ◽  
Radiation Dose ◽  
Small Animal ◽  
Pencil Beam ◽  
Computed Tomography Imaging ◽  
Step Size ◽  
Imaging Protocol ◽  
X Ray ◽  
Beam Geometry ◽  
Muscle Tissues

BACKGROUND: Pencil beam X-ray luminescence computed tomography (XLCT) imaging provides superior spatial resolution than other imaging geometries like sheet beam and cone beam geometries. However, the pencil beam geometry suffers from long scan times, resulting in concerns overdose which discourages the use of pencil beam XLCT. OBJECTIVE: The dose deposited in pencil beam XLCT imaging was investigated to estimate the dose from one angular projection scan with three different X-ray sources. The dose deposited in a typical small animal XLCT imaging was investigated. METHODS: A Monte Carlo simulation platform, GATE (Geant4 Application for Tomographic Emission) was used to estimate the dose from one angular projection scan of a mouse leg model with three different X-ray sources. Dose estimations from a six angular projection scan by three different X-ray source energies were performed in GATE on a mouse trunk model composed of muscle, spine bone, and a tumor. RESULTS: With the Sigray source, the bone marrow of mouse leg was estimated to have a radiation dose of 44 mGy for a typical XLCT imaging with six angular projections, a scan step size of 100 micrometers, and 106 X-ray photons per linear scan. With the Sigray X-ray source and the typical XLCT scanning parameters, we estimated the dose of spine bone, muscle tissues, and tumor structures of the mouse trunk were 38.49 mGy, 15.07 mGy, and 16.87 mGy, respectively. CONCLUSION: Our results indicate that an X-ray benchtop source (like the X-ray source from Sigray Inc.) with high brilliance and quasi-monochromatic properties can reduce dose concerns with the pencil beam geometry. Findings of this work can be applicable to other imaging modalities like X-ray fluorescence computed tomography if the imaging protocol consists of the pencil beam geometry.

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