Radiation exposure to the physician in interventional pain management

Fluoroscopy is an integral part of the practice of interventional pain management in present day modern medical practices. The major purpose of fluoroscopy in interventional pain management is correct needle placement to ensure target specificity and accurate delivery of the injectate. Fluoroscopy has become mandatory for multiple procedures based either on the definition of the procedure or the requirement of third parties. The most commonly used fluoroscopy in interventional pain management is with C-arm fluoroscopes with image intensification. Fluoroscopy is associated with risk for patients, clinicians, and the personnel in the operating room unless it is managed with appropriate understanding, skill, and vigilance. A total of 1,000 consecutive patients undergoing interventional procedures with chronic pain performed by one physician were studied. Two fluoroscopy units were utilized and operated by two certified radiological technologists. The procedures performed included caudal and interlaminar epidural injections, facet joint nerve blocks, percutaneous adhesiolysis, intercostal nerve blocks, sympathetic blocks, transforaminal epidural injections, along with other procedures. Results showed that a total of 1,000 patients underwent 1,729 procedures with average radiation exposure of 13.2 +/- 0.33 seconds per patient and 7.7 +/- 0.21 seconds per procedure. Dosimetry measurements showed total exposure of 1,345 mREM outside the apron and 0 mREM inside the apron during this period. The average exposure outside the apron was 1.345 mREM per patient and 0.778 mREM per procedure outside the apron and 0 mREM inside the apron. The levels of exposure are significantly below the annual limits recommended. It is concluded that it is feasible to perform all procedures under fluoroscopy in the described setting safely and effectively in interventional pain management.