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Intraarticular Sacroiliac Joint Injection Under Computed Tomography Fluoroscopic Guidance: A Technical Note to Reduce Procedural Time and Radiation Dose.

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Radiation Dose Reduction in CT Fluoroscopy-Guided Cervical Transforaminal Epidural Steroid Injection by Modifying

Nam Chull Paik¹

¹Department of Radiology, Arumdaun Wooldul Spine Hospital, 647-4 Sinjeong 2-dong, Nam-gu, Ulsan, 680-828, Republic of Korea. pncspine@gmail.com.

Cardiovascular and Interventional Radiology

|October 24, 2015

Summary

Radiation dose reduction in CT fluoroscopy-guided cervical transforaminal epidural steroid injections is achievable. Modifying planning scans significantly lowers radiation exposure without impacting technical success rates.

Keywords:

Cervical Computed tomography fluoroscopy Injection Radiation dose Transforaminal

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Area of Science:

Medical Imaging
Interventional Radiology
Radiation Safety

Background:

CT fluoroscopy (CTF)-guided cervical transforaminal epidural steroid injection (TFESI) procedures are associated with significant radiation exposure.
The majority of radiation dose in CTF-guided cervical TFESI originates from the planning CT scan, not the fluoroscopy itself.

Purpose of the Study:

To evaluate the effectiveness of replacing the planning helical CT with a spot CTF in reducing radiation dose.
To determine if this protocol modification compromises the technical performance of CTF-guided cervical TFESI.

Main Methods:

A retrospective analysis of 338 consecutive CTF-guided cervical TFESI procedures was conducted.
The study compared a control group (n=163) with a study group (n=175) that underwent protocol modification (spot CTF instead of helical CT).
Key metrics analyzed included technical success rate, dose-length product (DLP), inadvertent contrast flow, CTF acquisitions, and procedural time.

Main Results:

The study group achieved a significant reduction in median dose-length product (DLP) by 79.7% compared to the control group (7.92 vs. 39.05 mGy·cm, P < 0.001).
Technical success rates were high and comparable in both groups (100%).
No significant differences were observed in inadvertent contrast flow incidence, number of CTF acquisitions, or procedural time between the groups.

Conclusions:

Modifying scout and planning steps in CTF-guided cervical TFESI by using a spot CTF significantly reduces radiation dose.
This protocol modification achieves substantial radiation dose reduction without compromising technical performance or safety.
The findings support the adoption of this modified protocol for safer CTF-guided cervical TFESI procedures.