Diagnostic reference levels for X-ray investigations in pain management units in Belgium

X-rays are commonly used in pain treatment centres where infiltrative techniques are performed. Although X-rays are useful in increasing the precision of infiltrative techniques, their use puts patients and staff at risk of radiation exposure. As a result, medical staff now have to obtain a certificate of training on the use of X-rays before being allowed to use X-rays in practice. This analysis was based on 373 detailed registrations of procedure-related parameters in the six centres that participated in this study between January 2009 and July 2009. Examinations chosen for inclusion in this study were the most commonly performed fluoroscopic imaging-guided procedures in a pain management unit: epidurals (cervical/lumbar), facet joint nerve blocks (cervical/lumbar) and transforaminal (cervical/lumbar). The sample size, the dose-area product (DAP) range for whole population, the mean and the third quartile DAP corrected for patient size (DAP(corr)), the screening time range, the mean and the third quartile screening time are presented. The proposed DRLs for epidurals, facet joint nerve blocks and transforaminal are 0.5, 2.5 and 3 Gy cm² for DAP values and 12, 60 and 50 s for screening times, respectively. In the absence of national diagnostic reference levels (DRLs) for pain management fluoroscopic procedures, these DAP and screening time values provide a possible way of establishing provisional DRLs for local use. The values for each examination type could be used as a baseline against which to monitor the effectiveness of dose reduction strategies as part of the optimisation process that is the goal of any quality control and patient dose monitoring system.