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Pholsawatchai W, Manakul P, Lertcheewanan W, Siribumrungwoung K, Suntharapa T, Arunakul R. Comparison of Efficacy between Transforaminal Epidural Steroid Injection Technique without Contrast versus with Contrast in Lumbar Radiculopathy: A Prospective Longitudinal Cohort Study. Asian Spine J 2023; 17:1108-1116. [PMID: 37946336 PMCID: PMC10764127 DOI: 10.31616/asj.2023.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/27/2023] [Accepted: 05/24/2023] [Indexed: 11/12/2023] Open
Abstract
STUDY DESIGN A prospective longitudinal cohort study. PURPOSE To evaluate the efficacy of two different techniques of transforaminal epidural steroid injection (TFESI) with contrast and without contrast in treating lumbar radiculopathy. OVERVIEW OF LITERATURE Epidural injections are one of the most frequently used nonsurgical treatment options for managing lumbar radiculopathy. This study aims to simplify the TFESI technique, which is effective and requires less effort to replicate. METHODS We collected data on 118 patients who underwent TFESI without contrast versus TFESI with contrast for lumbar radiculopathy. The pain was evaluated using a Numerical Rating Scale (NRS) for pain at 5 minutes, 2 hours, 2 weeks, and 2 months. The functional status was assessed using the Oswestry Disability Index (ODI) score. The operation time and fluoroscopic dosage were also measured using this score. RESULTS Two groups of patients with radiculopathy were studied, comprising of 56 patients in the non-contrast group (NC group) and 62 patients in the contrast group (C group). There was a significant decrease in pain, as evaluated by NRS, in the C group compared to the NC group at 5 minutes post-procedure (3.39±1.54 vs. 3.86±0.72, with a p-value of 0.039). There was no significant difference in NRS scores at 2 hours, 2 weeks, and 2 months, as well as in ODI scores. The operation time and fluoroscopic dosage were lower in the group without contrast compared to the contrast group, with 12.58±3.30 minutes per level vs. 16.70±5.94 minutes per level (p <0.001) and 3.62±1.66 mGy vs. 5.32±2.74 mGy per level (p =0.014), respectively. No complications were reported in either group. CONCLUSIONS There is no difference in pain and functional outcome when treating lumbar radiculopathy with or without contrast using TFESI. The TFESI without contract technique has a shorter operation time and lower intra-operative fluoroscopic dosage without complications.
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Affiliation(s)
- Waroot Pholsawatchai
- Chulabhorn International College of Medicine, Thammasat University, Pathumthani,
Thailand
| | - Park Manakul
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathumthani,
Thailand
| | - Warisara Lertcheewanan
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathumthani,
Thailand
| | | | - Thongchai Suntharapa
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathumthani,
Thailand
| | - Rattalerk Arunakul
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathumthani,
Thailand
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Kim CL, Jeong HC, Kim JH. Radiation shielding effects of lead equivalent thickness of a radiation protective apron and distance during C-arm fluoroscopy-guided pain interventions: A randomized trial. Medicine (Baltimore) 2023; 102:e36447. [PMID: 38050291 PMCID: PMC10695529 DOI: 10.1097/md.0000000000036447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND The present study aimed to evaluate the degree of radiation shielding effects according to lead equivalent thickness and distance during C-arm fluoroscopy-guided lumbar interventions. METHODS The exposure time and air kerma were recorded using a fluoroscope. The effective dose (ED) was measured with and without the shielding material of the lead apron using 2 dosimeters at 2 positions. According to the lead equivalent thickness of the shielding material and distance from the side of the table, the groups were divided into 4 groups: group 1 (lead equivalent thickness 0.6 mm, distance 0 cm), group 2 (lead equivalent thickness 0.6 mm, distance 5 cm), group 3 (lead equivalent thickness 0.3 mm, distance 0 cm), and group 4 (lead equivalent thickness 0.3 mm, distance 5 cm). Mean differences such as air kerma, exposure time, ED, and ratio of EDs (ED with protector/ED without protector) were analyzed. RESULTS A total of 400 cases (100 cases in each group) were collected. The ratio of ED was significantly lower in groups 1 and 2 (9.18 ± 2.78% and 9.56 ± 3.29%, respectively) when compared to that of groups 3 and 4 (21.93 ± 4.19% and 21.53 ± 4.30%, respectively). The reductive effect of a 5-cm distance was 33.3% to 36.1% when comparing the ED between groups 1 and 2 and groups 3 and 4. CONCLUSIONS The 0.3- and 0.6-mm lead equivalent thickness protectors have a radiation attenuation effect of 78.1% to 78.5% and 90.4% to 90.8%, respectively. The 5-cm distance from the side of the table reduces radiation exposure by 33.3% to 36.1%.
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Affiliation(s)
- Cho Long Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
- Department of Clinical Science, Konkuk University Graduate School of Medicine, Konkuk University School Seoul, Seoul, Republic of Korea
| | - Hae Chang Jeong
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
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Alkosha HM. Interventional non-operative management of low back and neck pain. EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-023-00189-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Abstract
Background
Chronic neck and back pain are among the most commonly encountered health problems in neurosurgical practice. Many cases fail prolonged pharmacological and physical therapy and are not proper candidates for surgical interventions, or had refused proposed surgical treatment.
Objective
To provide an informative critical summary of the literature about the topic of interventional management of axial neck and low back pain and highlighting the new trends and pieces of evidence.
Methods
The English literature published over the last two decades was reviewed by the author for recent and relevant data about the principles of interventional management of chronic neck and low back pain. A PubMed search was performed through phrase searching and combined searching using Boolean operators. The articles thought to be most relevant to the study aim and the neurosurgeons’ practice were extracted.
Results
Neck and low back pain continue to be among the most common musculoskeletal health problems and the most common cause of disability worldwide. A detailed understanding of relevant spine anatomy is crucial for interventionists who should deal with the concept of “functional spine unit” with multiple potential pain generators. Chronic spinal pain is best managed through a dedicated multidisciplinary team in well-equipped healthcare facilities. An algorithmic approach for the diagnosis and management of spinal pain is the mainstay of providing the best patient care and should be based on the commonality and treatability of pain generators, values of patients and available resources.
Conclusion
Management of chronic neck and back pain can represent a clinical dilemma due to the multiplicity of pain generators that may coexist in the same individual resulting in a complex type and pattern of pain. Approach to these patients requires contributions from the members of a multidisciplinary team, implementing a standardized approach in a well-equipped healthcare facility.
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Okonkwo UC, Ohagwu CC, Aronu ME, Okafor CE, Idumah CI, Okokpujie IP, Chukwu NN, Chukwunyelu CE. Ionizing radiation protection and the linear No-threshold controversy: Extent of support or counter to the prevailing paradigm. JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2022; 253-254:106984. [PMID: 36057228 DOI: 10.1016/j.jenvrad.2022.106984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/07/2022] [Indexed: 06/15/2023]
Abstract
This study has developed a relationship that categorized radiation protection and allows for a proper, clear, and concise review of the different classifications in terms of principles of protection, dose criteria, categories, fundamental tools, exposure situations, applications and control measures. With the groundwork laid, advances of the linear no-threshold (LNT) model which has attracted attention in the field of radiobiology and epidemiology were examined in detail. Various plausible dose-response relationship scenarios were x-rayed under low-dose extrapolation. Intensive review of factors opposing the LNT model involving radiophobia (including misdiagnosis, alternative surgery/imaging, suppression of ionizing radiation (IR) research); radiobiology (including DNA damage repair, apoptosis/necrosis, senescence protection) and cost issues (including-high operating cost of LNT, incorrect prioritization, exaggeration of LNT impact, risk-to-benefit analysis) were performed. On the other hand, factors supporting the use of LNT were equally examined, they include regulatory bodies' endorsement, insufficient statistical significance, partial DNA repair, variability of irradiated bodies, different latency periods for cancer, dynamic nature of threshold and conflicting interests. After considering the gaps in the scientific investigations that either support or counter the scientific paradigm on the use of LNT model, further research and advocacy is recommended that will ultimately lead to the acceptance of an alternative paradigm by the international regulators.
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Affiliation(s)
- Ugochukwu C Okonkwo
- Department of Mechanical Engineering, Nnamdi Azikiwe University, Awka, Nigeria.
| | - Christopher C Ohagwu
- Department of Radiography and Radiological Sciences, Nnamdi Azikiwe University, Awka, Nigeria
| | - Michael E Aronu
- Department of Radiology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Christian E Okafor
- Department of Mechanical Engineering, Nnamdi Azikiwe University, Awka, Nigeria
| | - Christopher I Idumah
- Department of Polymer and Textile Engineering, Nnamdi Azikiwe University, Awka, Nigeria
| | - Imhade P Okokpujie
- Department of Mechanical and Mechatronic Engineering, Afe-Babalola University, Ado-Ekiti, Nigeria
| | - Nelson N Chukwu
- National Engineering Design Development Institute, Nnewi, Anambra State, Nigeria
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Park S, Kim M, Kim JH. Radiation safety for pain physicians: principles and recommendations. Korean J Pain 2022; 35:129-139. [PMID: 35354676 PMCID: PMC8977205 DOI: 10.3344/kjp.2022.35.2.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/12/2022] [Accepted: 02/13/2022] [Indexed: 11/05/2022] Open
Abstract
C-arm fluoroscopy is a useful tool for interventional pain management. However, with the increasing use of C-arm fluoroscopy, the risk of accumulated radiation exposure is a significant concern for pain physicians. Therefore, efforts are needed to reduce radiation exposure. There are three types of radiation exposure sources: (1) the primary X-ray beam, (2) scattered radiation, and (3) leakage from the X-ray tube. The major radiation exposure risk for most medical staff members is scattered radiation, the amount of which is affected by many factors. Pain physicians can reduce their radiation exposure by use of several effective methods, which utilize the following main principles: reducing the exposure time, increasing the distance from the radiation source, and radiation shielding. Some methods reduce not only the pain physician's but also the patient's radiation exposure. Taking images with collimation and minimal use of magnification are ways to reduce the intensity of the primary X-ray beam and the amount of scattered radiation. It is also important to carefully select the C-arm fluoroscopy mode, such as pulsed mode or low-dose mode, for ensuring the physician's and patient's radiation safety. Pain physicians should practice these principles and also be aware of the annual permissible radiation dose as well as checking their radiation exposure. This article aimed to review the literature on radiation safety in relation to C-arm fluoroscopy and provide recommendations to pain physicians during C-arm fluoroscopy-guided interventional pain management.
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Affiliation(s)
- Sewon Park
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Minjung Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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Abstract
There has been a rapid development in the field of interventional radiology over recent years, and this has led to a rapid increase in the number of interventional radiology procedures being performed. There is, however, a growing concern regarding radiation exposure to the patients and the operators during these procedures. In this article, we review the basics of radiation exposure, radiation protection techniques, radiation protection tools available to interventional radiologists, and radiation protection during pregnancy.
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Affiliation(s)
- Tushar Garg
- Department of Interventional Radiology, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Apurva Shrigiriwar
- Department of Interventional Radiology, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
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Hong SW, Kim TW, Kim JH. RADIATION EXPOSURE TO THE BACK WITH DIFFERENT TYPES OF APRONS. RADIATION PROTECTION DOSIMETRY 2021; 193:185-189. [PMID: 33839791 DOI: 10.1093/rpd/ncab044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/17/2021] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
Physicians and nurses stand with their back towards the C-arm fluoroscope when using the computer, taking things out of closets and preparing drugs for injection or instruments for intervention. This study was conducted to investigate the relationship between the type of lead apron and radiation exposure to the backs of physicians and nurses while using C-arm fluoroscopy. We compared radiation exposure to the back in the three groups: no lead apron (group C), front coverage type (group F) and wrap-around type (group W). The other wrap-around type apron was put on the bed instead of on a patient. We ran C-arm fluoroscopy 40 times for each measurement. We collected the air kerma (AK), exposure time (ET) and effective dose (ED) of the bedside table, upper part and lower part of apron. We measured these variables 30 times for each location. In group F, ED of the upper part was the highest (p < 0.001). ED of the lower part in group C and F was higher than that in group W (p = 0.012). The radiation exposure with a front coverage type apron is higher than that of the wrap-around type and even no apron at the neck or thyroid. For reducing radiation exposure to the back of physician or nurse, the wrap-around type apron is recommended. This type of apron can reduce radiation to the back when the physician turns away from the patient or C-arm fluoroscopy.
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Affiliation(s)
- Seung Wan Hong
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Tae Won Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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Choi EJ, Go G, Han WK, Lee PB. Radiation exposure to the eyes and thyroid during C-arm fluoroscopy-guided cervical epidural injections is far below the safety limit. Korean J Pain 2020; 33:73-80. [PMID: 31888321 PMCID: PMC6944368 DOI: 10.3344/kjp.2020.33.1.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 11/05/2022] Open
Abstract
Background The aim of this study was to evaluate radiation exposure to the eye and thyroid in pain physicians during the fluoroscopy-guided cervical epidural block (CEB). Methods Two pain physicians (a fellow and a professor) who regularly performed C-arm fluoroscopy-guided CEBs were included. Seven dosimeters were used to measure radiation exposure, five of which were placed on the physician (forehead, inside and outside of the thyroid protector, and inside and outside of the lead apron) and two were used as controls. Patient age, sex, height, and weight were noted, as were radiation exposure time, absorbed radiation dose, and distance from the X-ray field center to the physician. Results One hundred CEB procedures using C-arm fluoroscopy were performed on comparable patients. Only the distance from the X-ray field center to the physician was significantly different between the two physicians (fellow: 37.5 ± 2.1 cm, professor: 41.2 ± 3.6 cm, P = 0.03). The use of lead-based protection effectively decreased the absorbed radiation dose by up to 35%. Conclusions Although there was no difference in radiation exposure between the professor and the fellow, there was a difference in the distance from the X-ray field during the CEBs. Further, radiation exposure can be minimized if proper protection (thyroid protector, leaded apron, and eyewear) is used, even if the distance between the X-ray beam and the pain physician is small. Damage from frequent, low-dose radiation exposure is not yet fully understood. Therefore, safety measures, including lead-based protection, should always be enforced.
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Affiliation(s)
- Eun Joo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gwangcheol Go
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woong Ki Han
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Pyung-Bok Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
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Dietrich TJ, Peterson CK, Zeimpekis KG, Bensler S, Sutter R, Pfirrmann CWA. Fluoroscopy-guided versus CT-guided Lumbar Steroid Injections: Comparison of Radiation Exposure and Outcomes. Radiology 2019; 290:752-759. [DOI: 10.1148/radiol.2018181224] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Tobias J. Dietrich
- From the Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland (T.J.D., C.K.P., S.B., R.S., C.W.A.P.); Division of Medical Physics, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (K.G.Z.); and Faculty of Medicine, University of Zurich, Zurich, Switzerland (T.J.D., C.K.P., K.G.Z., S.B., R.S., C.W.A.P.)
| | - Cynthia K. Peterson
- From the Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland (T.J.D., C.K.P., S.B., R.S., C.W.A.P.); Division of Medical Physics, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (K.G.Z.); and Faculty of Medicine, University of Zurich, Zurich, Switzerland (T.J.D., C.K.P., K.G.Z., S.B., R.S., C.W.A.P.)
| | - Konstantinos G. Zeimpekis
- From the Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland (T.J.D., C.K.P., S.B., R.S., C.W.A.P.); Division of Medical Physics, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (K.G.Z.); and Faculty of Medicine, University of Zurich, Zurich, Switzerland (T.J.D., C.K.P., K.G.Z., S.B., R.S., C.W.A.P.)
| | - Susanne Bensler
- From the Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland (T.J.D., C.K.P., S.B., R.S., C.W.A.P.); Division of Medical Physics, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (K.G.Z.); and Faculty of Medicine, University of Zurich, Zurich, Switzerland (T.J.D., C.K.P., K.G.Z., S.B., R.S., C.W.A.P.)
| | - Reto Sutter
- From the Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland (T.J.D., C.K.P., S.B., R.S., C.W.A.P.); Division of Medical Physics, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (K.G.Z.); and Faculty of Medicine, University of Zurich, Zurich, Switzerland (T.J.D., C.K.P., K.G.Z., S.B., R.S., C.W.A.P.)
| | - Christian W. A. Pfirrmann
- From the Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland (T.J.D., C.K.P., S.B., R.S., C.W.A.P.); Division of Medical Physics, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (K.G.Z.); and Faculty of Medicine, University of Zurich, Zurich, Switzerland (T.J.D., C.K.P., K.G.Z., S.B., R.S., C.W.A.P.)
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The Influence of Local Anesthesia Depth on Procedural Pain During Fluoroscopically Guided Lumbar Transforaminal Epidural Injections: A Randomized Clinical Trial. Am J Phys Med Rehabil 2018; 98:253-257. [PMID: 30153126 DOI: 10.1097/phm.0000000000001032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the influence of the depth of local anesthesia application on procedural pain during lumbar transforaminal epidural steroid injection. DESIGN Sixty-eight patients were enrolled who were scheduled for single-level, unilateral fluoroscopically guided lumbar transforaminal epidural steroid injection. Patients were randomly allocated to receive either subcutaneous local anesthesia (group S) or deep local anesthesia (group D) for transforaminal epidural steroid injection. The data related to pain and technical performance during the procedure was compared. In addition, the incidence of injection site soreness was assessed 2 wks after transforaminal epidural steroid injection. RESULTS Sixty-seven patients completed all assessments (group S, n = 33; group D, n = 34). There was no significant difference in procedural pain and discomfort level between the groups (P = 0.151, P = 0.183, respectively). Patients in group D showed lower behavioral pain scores (P = 0.017). There was no significant difference in the numbers of needle manipulations, fluoroscopy time, and radiation dose during the procedure between the groups. Two patients in group S and three in group D complained of injection site soreness after transforaminal epidural steroid injection for a few days, but there was no significant difference in its incidence (P = 0.667). CONCLUSIONS Deep local anesthesia to reduce procedural pain during transforaminal epidural steroid injection seems to have no significant clinical benefit compared with conventional subcutaneous local anesthesia. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Reduce procedural pain by considering clinical factors of the patient during fluoroscopically guided lumbar transforaminal epidural injections.Upon completion of this article, the reader should be able to: (1) Understand the potential impact of procedural pain on the performance of transforaminal epidural steroid injections; (2) Distinguish cutaneous nociceptive afferents from nociceptive afferents in muscle; and (3) Explain the factors to reduce procedural pain during fluoroscopically guided lumbar transforaminal epidural injections. LEVEL Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Kim JH. Three principles for radiation safety: time, distance, and shielding. Korean J Pain 2018; 31:145-146. [PMID: 30013728 PMCID: PMC6037814 DOI: 10.3344/kjp.2018.31.3.145] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 06/19/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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Gieroba TJ, Williams N, Antoniou G, Cundy PJ. Mini C-arm: faster, cheaper, safer? ANZ J Surg 2016; 87:282-286. [DOI: 10.1111/ans.13842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 08/28/2016] [Accepted: 10/08/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Tom J. Gieroba
- Discipline of Orthopaedics and Trauma; The University of Adelaide; Adelaide South Australia Australia
- Department of Orthopaedic Surgery; Women's and Children's Hospital; North Adelaide South Australia Australia
| | - Nicole Williams
- Department of Orthopaedic Surgery; Women's and Children's Hospital; North Adelaide South Australia Australia
- Centre for Orthopaedic and Trauma Research; The University of Adelaide; Adelaide South Australia Australia
| | - Georgia Antoniou
- Department of Orthopaedic Surgery; Women's and Children's Hospital; North Adelaide South Australia Australia
| | - Peter J. Cundy
- Discipline of Orthopaedics and Trauma; The University of Adelaide; Adelaide South Australia Australia
- Department of Orthopaedic Surgery; Women's and Children's Hospital; North Adelaide South Australia Australia
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Gieroba TJ, Bain GI, Cundy PJ. Review of the Clinical Use of Fluoroscopy in Hand Surgery. ACTA ACUST UNITED AC 2015; 20:228-36. [DOI: 10.1142/s021881041530003x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fluoroscopy is a commonly used tool in hand surgery. There have been recent advances in the technology and its clinical utilisation. Indications include assessment of joint and fracture fixation and stability, particularly when combined with minimally invasive techniques. Recent developments include surgeon operated mini C-arm image intensifiers. We present a review of the clinical utilisation of fluoroscopy in hand surgery including recent developments, Australian legislation, safety issues, strategies to reduce radiation exposure and clinical examples for imaging distal radius and scaphoid fracture fixation.
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Affiliation(s)
- Tom J. Gieroba
- Discipline of Orthopaedics and Trauma, University of Adelaide, Australia
| | - Gregory I. Bain
- Discipline of Orthopaedics and Trauma, University of Adelaide, Australia
- Department of Orthopaedic Surgery, Flinders University, Australia
| | - Peter J. Cundy
- Discipline of Orthopaedics and Trauma, University of Adelaide, Australia
- Department of Orthopaedic Surgery, Women's and Children's Hospital, North Adelaide, South Australia, Australia
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Shim JH. Radiation Safety for Pain Physicians: Technique or Equipment. Korean J Pain 2014; 27:101-2. [PMID: 24748936 PMCID: PMC3990816 DOI: 10.3344/kjp.2014.27.2.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 03/14/2014] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jae Hang Shim
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
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Kim AN, Chang YJ, Cheon BK, Kim JH. How Effective Are Radiation Reducing Gloves in C-arm Fluoroscopy-guided Pain Interventions? Korean J Pain 2014; 27:145-51. [PMID: 24748943 PMCID: PMC3990823 DOI: 10.3344/kjp.2014.27.2.145] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 12/26/2013] [Accepted: 01/17/2014] [Indexed: 12/26/2022] Open
Abstract
Background The physician's hands are close to the X-ray field in C-arm fluoroscopy-guided pain interventions. We prospectively investigated the radiation attenuation of Proguard RR-2 gloves. Methods In 100 cases, the effective doses (EDs) of two dosimeters without a radiation-reducing glove were collected. EDs from the two dosimeters-one dosimeter wrapped with a glove and the other dosimeter without a glove- were also measured at the side of the table (Group 1, 140 cases) and at a location 20 cm away from the side of the table (Group 2, 120 cases). Mean differences such as age, height, weight, radiation absorbed dose (RAD), exposure time, ED, and ratio of EDs were analyzed. Results In the EDs of two dosimeters without gloves, there were no significant differences (39.0 ± 36.3 µSv vs. 38.8 ± 36.4 µSv) (P = 0.578). The RAD (192.0 ± 182.0 radcm2) in Group 2 was higher than that (132.3 ± 103.5 radcm2) in Group 1 (P = 0.002). The ED (33.3 ± 30.9 µSv) of the dosimeter without a glove in Group 1 was higher than that (12.3 ± 8.8 µSv) in Group 2 (P < 0.001). The ED (24.4 ± 22.4 µSv) of the dosimeter wrapped with a glove in Group 1 was higher than that (9.2 ± 6.8 µSv) in Group 2 (P < 0.001). No significant differences were noted in the ratio of EDs (73.5 ± 6.7% vs. 74.2 ± 9.3%, P = 0.469) between Group 1 and Group 2. Conclusions Proguard RR-2 gloves have a radiation attenuation effect of 25.8-26.5%. The radiation attenuation is not significantly different by intensity of scatter radiation or the different RADs of C-arm fluoroscopy.
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Affiliation(s)
- Ah Na Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Young Jae Chang
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Bo Kyung Cheon
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea
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Chang YJ, Kim AN, Oh IS, Woo NS, Kim HK, Kim JH. The Radiation Exposure of Radiographer Related to the Location in C-arm Fluoroscopy-guided Pain Interventions. Korean J Pain 2014; 27:162-7. [PMID: 24748945 PMCID: PMC3990825 DOI: 10.3344/kjp.2014.27.2.162] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 12/20/2013] [Accepted: 12/20/2013] [Indexed: 11/12/2022] Open
Abstract
Background Although a physician may be the nearest to the radiation source during C-arm fluoroscope-guided interventions, the radiographer is also near the fluoroscope. We prospectively investigated the radiation exposure of radiographers relative to their location. Methods The effective dose (ED) was measured with a digital dosimeter on the radiographers' left chest and the side of the table. We observed the location of the radiographers in each procedure related to the mobile support structure of the fluoroscope (Groups A, M and P). Data about age, height, weight, sex, exposure time, radiation absorbed dose (RAD), and the ED at the radiographer's chest and the side of the table was collected. Results There were 51 cases for Group A, 116 cases for Group M and 144 cases for Group P. No significant differences were noted in the demographic data such as age, height, weight, and male to female ratio, and exposure time, RAD and ED at the side of the table. Group P had the lowest ED (0.5 ± 0.8 µSv) of all the groups (Group A, 1.6 ± 2.3 µSv; Group M, 1.3 ± 1.9 µSv; P < 0.001). The ED ratio (ED on the radiographer's chest/ED at the side of the table) of Group A was the highest, and the ED radio of Group P was the lowest of all the groups (Group A, 12.2 ± 21.5%; Group M, 5.7 ± 6.5%; Group P, 2.5 ± 6.7%; P < 0.001).
Conclusions Radiographers can easily reduce their radiation exposure by changing their position. Two steps behind the mobile support structure can effectively decrease the exposure of radiographers by about 80%.
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Affiliation(s)
- Young Jae Chang
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Ah Na Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea
| | - In Su Oh
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Nam Sik Woo
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Hae Kyoung Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea
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Kim JH. Replay to the Letter: Are Doctors Exposed to Radiation Even When Wearing Protectors during Fluoroscopic Procedures? Korean J Pain 2013; 26:208. [PMID: 23614090 PMCID: PMC3629355 DOI: 10.3344/kjp.2013.26.2.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 03/20/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Seoul, Korea
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Jo DH. Are Doctors Exposed to Radiation Even When Wearing Protectors during Fluoroscopic Procedures? Korean J Pain 2013; 26:207. [PMID: 23614089 PMCID: PMC3629354 DOI: 10.3344/kjp.2013.26.2.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 03/20/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Dae Hyun Jo
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
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