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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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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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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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Cheon BK, Kim CL, Kim KR, Kang MH, Lim JA, Woo NS, Rhee KY, Kim HK, Kim JH. Radiation safety: a focus on lead aprons and thyroid shields in interventional pain management. Korean J Pain 2018; 31:244-252. [PMID: 30310549 PMCID: PMC6177538 DOI: 10.3344/kjp.2018.31.4.244] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/26/2018] [Accepted: 06/18/2018] [Indexed: 12/19/2022] Open
Abstract
C-arm fluoroscopy is useful equipment in interventional pain management because it helps to guide correct needle targeting for the accurate injection and drug delivery. However, due to increased use of C-arm fluoroscopy in various pain procedures, the risk of radiation exposure is a significant concern for pain physicians. The harmful biological effects of ionizing radiation on the human body are well known. It is therefore necessary to strive to reduce radiation exposure. Lead aprons with thyroid shields are the most fundamental radiation protective devices for interventional procedures, and are very effective. However, the operator's radiation safety cannot be guaranteed because pain physicians seem to lack sufficient interest, knowledge, and awareness about radiation safety. Also, inappropriate care and use of radiation protective devices may result in a higher risk of radiation exposure. The purpose of this article was to review the literature on radiation safety with a focus on lead aprons and thyroid shields and present recommendations related to those devices during C-arm fluoroscopic-guided interventions by pain physicians.
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Affiliation(s)
- Bo Kyung Cheon
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Cho Long Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Ka Ram Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Min Hye Kang
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jeong Ae Lim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Nam Sik Woo
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Ka Young Rhee
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hae Kyoung 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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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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Kim MJ, Kim JH. Radiation exposure and protection for eyes in pain management. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.4.297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Min Jung Kim
- Department Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Hun Kim
- Department Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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Kim TH, Hong SW, Woo NS, Kim HK, Kim JH. The radiation safety education and the pain physicians' efforts to reduce radiation exposure. Korean J Pain 2017; 30:104-115. [PMID: 28416994 PMCID: PMC5392654 DOI: 10.3344/kjp.2017.30.2.104] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND C-arm fluoroscopy equipment is important for interventional pain management and can cause radiation injury to physicians and patients. We compared radiation safety education and efforts to reduce the radiation exposure of pain specialists. METHODS A survey of 49 pain specialists was conducted anonymously in 2016. The questionnaire had 16 questions. That questionnaire was about radiation safety knowledge and efforts to reduce exposure. We investigated the correlation between radiation safety education and efforts of radiation protection. We compared the results from 2016 and a published survey from 2011. RESULTS According to the 2016 survey, all respondents used C-arm fluoroscopy in pain interventions. Nineteen respondents (39%) had received radiation safety education. Physicians had insufficient knowledge about radiation safety. When the radiation safety education group and the non-education group are compared, there was no significant difference in efforts to reduce radiation exposure and radiation safety knowledge. When the 2011 and 2016 surveys were compared, the use of low dose mode (P = 0.000) and pulsed mode had increased significantly (P = 0.001). The number checking for damage to radiation protective garments (P = 0.000) and use of the dosimeter had also increased significantly (P = 0.009). But there was no significant difference in other efforts to reduce radiation exposure. CONCLUSIONS Pain physicians seem to lack knowledge of radiation safety and the number of physicians receiving radiation safety education is low. According to this study, education does not lead to practice. Therefore, pain physicians should receive regular radiation safety education and the education should be mandatory.
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Affiliation(s)
- Tae Hee Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Seung Wan Hong
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Nam Sik Woo
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hae Kyoung 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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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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