Influence of resident involvement on fluoroscopy time and ionizing radiation exposure in fluoroscopy‐guided spinal procedures

Introduction

Fluoroscopic guidance has become the standard for a variety of medical procedures. Mastering these techniques requires practice, which may entail additional radiation for patients and providers. Despite their widespread use, the literature examining factors influencing radiation exposure in fluoroscopically guided pain procedures is scarce.

Objective

To evaluate the influence of resident involvement on radiation exposure during fluoroscopy‐guided spinal interventions.

Design

Single‐centre, observational study.

Setting

Outpatient physiatry clinic in a teaching hospital.

Patients

All patients who received cervical or lumbar facet block(s) (FBs), transforaminal epidural steroid injection(s) (TFESIs) without digital subtraction, or a caudal epidural (CE) during the study period were included.

Interventions

Resident involvement in the procedures: absent, observing, or participating.

Main Outcome Measures

Machine‐indicated fluoroscopy time (seconds) and radiation dose (milligrays).

Results

296 procedures were included: 188 FBs (58 cervical, 130 lumbar), 48 CEs and 60 TFESIs.

For lumbar FBs, fluoroscopy time and radiation dose increased significantly when residents performed (mean_time = 24.5s, CI = [20.4, 28.7] ; mean_dose = 3.53 mGy, CI = [2.57, 4.49]) compared to when they observed (mean_time = 9.9s, CI = [8.1, 11.7] ; mean_dose = 1.28 mGy, CI = [0.98, 1.59]) (mean difference: time = 14.63s, CI = [9.31, 19.94]; dose = 2.25 mGy, CI = [1.17, 3.33]) and were absent during the procedure (mean_time = 12.9s, CI = [11.1, 14.6] ; mean_dose = 1.65 mGy, CI = [1.40, 1.89]) (mean difference: time = 11.67s, CI = [7.35, 15.98]; dose = 1.88 mGy, CI = [1.01, 2.76]). In the case of TFESIs, time, but not dose, increased significantly when residents observed (mean_time = 39.1s, CI = [30.7, 47.6] ; mean_dose = 6.73 mGy, CI = [3.39, 10.07]) compared to when they were absent (mean_time = 27.1s, CI = [22.4, 31.8]; mean_dose = 4.41 mGy, CI = [3.06, 5.76] (mean difference: time = 11.99s, CI = [1.37, 22.61]; dose = 2.32 mGy, CI = [‐1.20, 5.84]). Finally, resident involvement did not significantly impact the outcomes for CEs (p_time= 0.032, p_dose = 0.74) and cervical FBs (p_time = 0.64, p_dose = 0.68).

Conclusion

Resident participation impacted lumbar facet blocks the most, with an increase in both fluoroscopy time and radiation dose.

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