Improved Dose Estimates for Fluoroscopically Guided Lumbar Epidural Injections.
DAP
Dose
Epidural
Fluoroscopy
Low Back Pain
Radiation
Journal
Pain medicine (Malden, Mass.)
ISSN: 1526-4637
Titre abrégé: Pain Med
Pays: England
ID NLM: 100894201
Informations de publication
Date de publication:
01 05 2019
01 05 2019
Historique:
pubmed:
15
9
2018
medline:
7
3
2020
entrez:
15
9
2018
Statut:
ppublish
Résumé
The goal of the study was to determine the potential impact of system inaccuracies and table attenuation on fluoroscope-reported dose values. An Institutional Review Board-approved study was conducted to collect detailed acquisition and patient exposure data for fluoroscopy-guided lumbar epidural injections. System-reported dosimetry values, especially the air Kinetic Energy Released per unit MAss and dose-area product metrics, are routinely used for estimating the radiation burden to patients undergoing fluoroscopy-guided procedures. However, these metrics do not account for other factors, such as acquisition geometry, where the table may attenuate a substantial fraction of the x-ray intensity, and system dosimetry inaccuracies, which are only required to be accurate within ±35%. Acquisition data from 46 patients undergoing fluoroscopy-guided lumbar epidural injections were collected to better estimate the true incident dose-area product. Gantry angles, x-ray technique factors, and field sizes were collected to characterize each procedure. Additionally, the fluoroscope dosimetry accuracy and table attenuation properties were evaluated as a function of kVp to generate the correction factors necessary for accurate dosimetry estimates. The system-reported values overestimated the total patient entrance dose-area product by an average of 34% (13-44%). Errors may be substantially higher for systems with less accurate fluoroscopes or more anterior-posterior projections. Correcting system-reported dosimetry values for systematic inaccuracies and variability can substantially improve fluoroscopic dose values. Including corrections for system output inaccuracies and acquisition factors such as table attenuation is necessary for any reliable assessment of radiation burden to patients associated with fluoroscopy-guided procedures.
Sections du résumé
OBJECTIVE
The goal of the study was to determine the potential impact of system inaccuracies and table attenuation on fluoroscope-reported dose values.
DESIGN
An Institutional Review Board-approved study was conducted to collect detailed acquisition and patient exposure data for fluoroscopy-guided lumbar epidural injections.
BACKGROUND
System-reported dosimetry values, especially the air Kinetic Energy Released per unit MAss and dose-area product metrics, are routinely used for estimating the radiation burden to patients undergoing fluoroscopy-guided procedures. However, these metrics do not account for other factors, such as acquisition geometry, where the table may attenuate a substantial fraction of the x-ray intensity, and system dosimetry inaccuracies, which are only required to be accurate within ±35%.
METHODS
Acquisition data from 46 patients undergoing fluoroscopy-guided lumbar epidural injections were collected to better estimate the true incident dose-area product. Gantry angles, x-ray technique factors, and field sizes were collected to characterize each procedure. Additionally, the fluoroscope dosimetry accuracy and table attenuation properties were evaluated as a function of kVp to generate the correction factors necessary for accurate dosimetry estimates.
RESULTS
The system-reported values overestimated the total patient entrance dose-area product by an average of 34% (13-44%). Errors may be substantially higher for systems with less accurate fluoroscopes or more anterior-posterior projections. Correcting system-reported dosimetry values for systematic inaccuracies and variability can substantially improve fluoroscopic dose values.
CONCLUSIONS
Including corrections for system output inaccuracies and acquisition factors such as table attenuation is necessary for any reliable assessment of radiation burden to patients associated with fluoroscopy-guided procedures.
Identifiants
pubmed: 30215781
pii: 5095912
doi: 10.1093/pm/pny172
doi:
Substances chimiques
Adrenal Cortex Hormones
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
971-978Informations de copyright
© 2018 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.