A Collaborative Approach to Dose Optimization in Fluoroscopy Guided Lumbar Spine Injection Procedures
K Brown*, P Kalapos, D Nguyen, K Thamburaj, T Rahman, Milton S. Hershey Medical Center, Penn State University, Hershey, PASU-C-217A-6 Sunday 1:30:00 PM - 2:15:00 PM Room: 217A
Purpose: To observe and evaluate technical acquisition and operating procedures used for lumbar spine injection procedures under fluoroscopy guidance performed by multiple neuroradiologists for potential patient dose reduction opportunities.
Methods: Baseline skin dose measurements were acquired on patients undergoing lumbar spine injection procedures on a bi-plane fluoroscopy unit. Optically stimulated luminescent dosimeters were placed on the patient's abdomen corresponding to the anterior-posterior plane beam entrance location and on the patient's right side corresponding to the lateral plane beam entrance location. Technical acquisition factors, treated levels, and patient demographics were recorded. In addition, observations were made of operating procedures such as the use of collimation and magnification, patient and equipment positioning, beam angulations, and exposure techniques used by individual neuroradiologists.
Results: Baseline data and observations were reviewed with neuroradiologists. Opportunities to reduce dose were discussed and a series of acquisition and practice changes accepted. Changes were implemented and skin dose measurements repeated. Results showed a reduction in skin dose of 64% and 79% respectively for anterior-posterior and lateral planes from baseline data. No adverse outcomes to procedure time, fluoroscopy time, or image quality were observed.
Conclusions: Practices among physicians can vary substantially. Collaboration and standardization of acquisition and operating procedures can result in substantial dose reduction for patients without compromising image quality or clinical productivity.