Radiation safety in fluoroscopy for neuraxial injections

Certified Registered Nurse Anesthetists (CRNAs) perform epidural steroid injections for chronic back and extremity pain. Placing epidural needles using fluoroscopy and confirming the needle placement by epidurogram has been suggested as a means to increase the efficacy of epidural injections while decreasing complications. Because of the risk of radiation injury to patients and staff when using fluoroscopy, the purpose of this article is to review the concepts of fluoroscopy and radiation safety for CRNAs. Following a literature search using keywords such as fluoroscopy, radiation injury, and radiation safety, relevant articles were identified. In addition, the reference lists of these articles were reviewed to identify other pertinent sources regarding this topic. The risks of stochastic and deterministic effects from radiation exposure necessitate the need for practitioners who are knowledgeable in equipment, patient, and procedure related factors that influence radiation exposure. Practitioner conduct, using the as-low-as-reasonably achievable (ALARA) principle, results in choices regarding these factors that minimize the time and intensity of radiation exposure to patients, anesthesia providers, and staff.