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Related Experiment Video

Updated: Feb 5, 2026

X-ray Dose Reduction through Adaptive Exposure in Fluoroscopic Imaging
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Improved Dose Estimates for Fluoroscopically Guided Lumbar Epidural Injections.

Steve D Mann1,2,3, Anand Joshi4,5, Megan Shonyo3

  • 1Clinical Imaging Physics Group, Duke University Health System, Durham, North Carolina, USA.

Pain Medicine (Malden, Mass.)
|September 15, 2018
PubMed
Summary

Fluoroscopic dose measurements often overestimate patient radiation exposure due to system inaccuracies and table attenuation. Correcting these values is crucial for accurate radiation burden assessment in procedures like lumbar epidural injections.

Keywords:
DAPDoseEpiduralFluoroscopyLow Back PainRadiation

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Area of Science:

  • Medical Physics
  • Radiology
  • Radiation Dosimetry

Background:

  • Fluoroscopy-guided procedures rely on system-reported dosimetry values like air Kinetic Energy Released per unit MAss and dose-area product for radiation burden estimation.
  • These metrics do not account for factors such as table attenuation and inherent system dosimetry inaccuracies (±35% required accuracy).

Purpose of the Study:

  • To determine the impact of system inaccuracies and table attenuation on fluoroscope-reported dose values.
  • To improve the accuracy of radiation dose assessment in fluoroscopy-guided procedures.

Main Methods:

  • Collected acquisition and patient exposure data from 46 patients undergoing fluoroscopy-guided lumbar epidural injections.
  • Evaluated fluoroscope dosimetry accuracy and table attenuation as a function of kVp to generate correction factors.
  • Characterized procedures using gantry angles, x-ray technique factors, and field sizes.

Main Results:

  • System-reported dose-area product values overestimated the total patient entrance dose-area product by an average of 34% (range: 13-44%).
  • Potential for substantially higher errors exists with less accurate fluoroscopes or anterior-posterior projections.
  • Correction of system-reported dosimetry values for inaccuracies and variability significantly improves dose value accuracy.

Conclusions:

  • Accurate assessment of patient radiation burden requires corrections for system output inaccuracies and acquisition factors like table attenuation.
  • Reliable dose estimation is essential for patient safety in fluoroscopy-guided interventions.