Comparison of Radiation Exposure during Fluoroscopy-Guided Transforaminal Epidural Steroid Injections at Different Vertebral Levels

황윤미,이민희,김선정,이신우,정혜원,이상훈,신명진 대한영상의학회 2015 Korean Journal of Radiology Vol.16 No.2

To estimate and compare radiation exposure during transforaminal fluoroscopy-guided epidural steroid injection (TFESI) at different vertebral levels. Fluoroscopy-guided TFESI was performed in 181 patients. The patients were categorized into three groups according to the injected lumbosacral nerve level of L2–4, L5, or S1. Fluoroscopy time (FT) and dose area product (DAP) were recorded for all patients; correlations between FT and DAP were determined at each level, and both FT and DAP were compared between the different vertebral levels. The numbers of patients who received ESI at L2–4, L5, and S1 were 29, 123, and 29. Mean FT was 44 seconds at L2–4, 33.5 seconds at L5, and 37.7 seconds at S1. Mean DAP was 138.6 μGy·m2 at L2–4, 100.6 μGy·m2 at L5, and 72.1 μGy·m2 at S1. FT and DAP were positively correlated in each group (p values < 0.001). FT was significantly shorter at L5 than that at L2–4 (p = 0.004) but was not significantly different between S1 and L2–4 or L5 (p values = 0.286 and 0.532, respectively). DAP was significantly smaller at L5 and S1 than that at L2–4, but L5 and S1 were not significantly different. After correcting for FT, DAP was significantly smaller at S1 than that at either L2–4 or L5 (p values = 0.001 and 0.010). The radiation dose was small during a single procedure of ESI and showed differences between different lumbosacral spine levels.

투시조영 검사에서의 면적선량의 측정 및 비교 : 식도조영, 상복부위장관조영, 연하조영 중심으로

노현아(Hyun A Noh),조한영(Han Yeong Cho),문규오(Kyoo O Moon),손순룡(Soon Lyong Son) 대한영상의학기술학회 2009 대한영상의학기술학회 논문지 Vol.2009 No.-

Purpose : This thesis is, esophagography, UGI series, swallowing study using DAP meter measure in checking and fluoroscopy time, body weight, to learn about the correlation with image number, compared with earlier studies and seek the ways of reducing the radiation dose. Materials and Methods : October- December 2008 was an experiment of 212 patients. Philips has used its equipment, DAP meter adherent in front of X-ray tube calibration, and using the ion-chamber. By checking the patients weight, fluoroscopy time, image number and DAP values were measured. Results : According to the increase in esophagography fluoroscopy time as an increase in the DAP had paid attention to statistics (P<0.05). In UGI series, according to the increase in weight, fluoroscopy time, image number as an increase in the DAP had paid attention to statistics (P<0.05). In swallowing study, fluoroscopy time and DAP had paid attention to statistics (P<0.05). In all test, depending on the increase in fluoroscopy time also DAP had increased gradually. In case of our hospital, the average DAP and fluoroscopy time with advanced studies to compare at least 2.4 times, respectively, 6.5 times as high was investigating. In UGI series, fluoroscopy time at least 1.7 times, DAP 2.6 times, image number also was 2.4 time higher. Conclusion : To reduce patient dose for fluoroscopy examination, in here and now, they should evaluate patient dose and accurately analyze related factors of exposure dose. It comes to the conclusion that patient dose is reduced in good image quality by perfonning the examinations for reference of advanced studies or recommend dose recommended dose in international organizations.

Radiation Dose Reduction and Surgical Efficiency Improvement in Endoscopic Transforaminal Lumbar Interbody Fusion Assisted by Intraoperative O-arm Navigation: A Retrospective Observational Study

Junfeng Gong,Xinle Huang,Liwen Luo,Huan Liu,Hao Wu,Ying Tan,Changqing Li,Yu Tang,Yue Zhou 대한척추신경외과학회 2022 Neurospine Vol.19 No.2

Objective: Endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) has gained increasing popularity among spine surgeons. However, with the use of fluoroscopy, intraoperative radiation exposure remains a major concern. Here, we aim to introduce Endo-TLIF assisted by O-arm-based navigation and compare the results between O-arm navigation and fluoroscopy groups. Methods: Sixty-four patients were retrospectively analyzed from May 2019 to September 2020; the nonnavigation group comprised 34 patients, and the navigation group comprised 30 patients. Data on radiation dose, blood loss, postoperative drains, surgery time, complications, and length of hospital stay (LOS) were collected. Clinical outcomes were evaluated from postoperative data such as fusion rate, Oswestry Disability Index (ODI), and visual analogue scale (VAS). Radiation dose and surgery time were selected as primary outcomes; the others were second outcomes. Results: All patients were followed up for at least 12 months. No significant differences were detected in intraoperative hemorrhage, postoperative drains, hospital LOS, or complications between the 2 groups. The radiation dose was significantly lower in the navigation group compared with the nonnavigation group. The time of cannula placement and pedicle screw fixation was significantly reduced in the navigation group. No significant differences were detected between the clinical outcomes in the 2 groups (VAS and ODI scores). Conclusion: The present study demonstrates that O-arm-assisted Endo-TLIF is efficient and safe. Compared with fluoroscopy, O-arm navigation could reduce the radiation exposure and surgical time in Endo-TLIF surgery, with similar clinical outcomes. However, the higher doses exposed to patients remains a negative effect of this technology.

경추 후지내측지 차단술에서 발생하는 혈관 내 주사의 빈도: 361건 시술에 대한 연구

이숙영 대한마취통증의학회 2008 Anesthesia and pain medicine Vol.3 No.4

Background: The prevalence of persistent neck pain, secondary to involvement of cervical facet or zygapophysial joints, has been described in controlled studies as varying from 39% to 67%. Cervical medial branch block (MBB) represents a useful interventional pain management procedure indicated in patients with a chronic neck pain of facet joint origin. In the current study, we prospectively evaluated the incidence of, and the factors associated with, intravascular injection during block. In addition, we assessed the efficiencies of generally accepted safety measures, such as pre-injection aspiration and intermittent fluoroscopy to avoid intravascular injections. Methods: We prospectively examined 361 cervical MBBs in 158 patients performed by 2 physicians. Aspiration test, spot radiography, and contrast injection under real-time fluoroscopic visualization were performed sequentially without repositioning the needle. Incidences of blood flash back and the presence of intravascular contrast spread on spot radiographic images and during real-time fluoroscopy were checked. The factors studied for intravascular injection included patient age and sex and block spinal level. Results: No specific factors were found to affect the incidence of intravascular uptake during block. The overall incidence of intravascular uptake was 3.3% per nerve block (12/361), and 7 of these were predicted by pre-injection aspiration (sensitivity = 58.3%) and 8 by spot radiography (sensitivity = 66.7%). Conclusions: The aspiration test with or without spot radiography frequently missed the intravascular uptake of contrast during cervical MBBs. We strongly advocate the use of real-time fluoroscopy during contrast injection to increase diagnostic and therapeutic value and to avoid possible complications.

Increased Bolus Volume Effect on Delayed Pharyngeal Swallowing Response in Post-stroke Oropharyngeal Dysphagia: A Pilot Study

Jin-Woo Park,Gyu-Jeong Sim,Dong-Chan Yang,Kyoung-Hwan Lee,Ji-Hea Chang,남기연,Hojun Lee,Bumsun Kwon 대한재활의학회 2016 Annals of Rehabilitation Medicine Vol.40 No.6

Objective To confirm a relationship between the pharyngeal response and bolus volume, and examine whether increasing the fluid bolus volume can improve penetration and aspiration for stroke dysphagic patients.Methods Ten stroke patients with a delayed pharyngeal response problem confirmed by a videofluoroscopic swallowing study (VFSS) were enrolled. Each subject completed two swallows each of 2 mL, 5 mL, and 10 mL of barium liquid thinned with water. The pharyngeal delay time (PDT) and penetration-aspiration scale (PAS) were measured and the changes among the different volumes were analyzed.Results PDTs were shortened significantly when 5 mL and 10 mL of thin barium were swallowed compared to 2 mL. However, there was no significant difference in PAS as the bolus volume increased. Conclusion The increased fluid bolus volume reduced the pharyngeal delay time, but did not affect the penetration and aspiration status.

중재적 방사선 시술 시 환자선량에 대한 참고 준위 비교

박혁(Hyeok Park),김용완(Yongwan Kim),전주섭(Juseob Jeon) 한국방사선학회 2012 한국방사선학회 논문지 Vol.6 No.1

중재적 방사선 시술 시 환자의 피폭선량을 시술별로 분류하여 측정 및 평가하여 안전관리 자료로 활용하고자 하였다. 검사는 시술별(TACE, EVAR, Iliac stent, Lower Limb, BAE, Embolization, PTBD, PTGBD, Abscess, Nephrostomy)로 투시시간, 면적선량, 영상획득이미지 수를 측정하였다. 시술별 분석결과 비혈관계 검사에서 전반적으로 낮은 값을 보였으며, 혈관계 검사에서는 IVC filter를 제외한 모든 검사에서 높은 값을 나타냈다. 투시시간은 EVAR가 24m30s로 가장 높았고, 면적선량 또한 EVAR가 236 Gy/㎠로 가장 높았다. 면적선량률은 TACE가 22.8 Gy/㎠로 높게 나타났다. 이 결과를 토대로 중재적 방사선시술시 환자피폭선량에 대한 기준선량을 제시하고자 한다. The purpose of this study is to measure and evaluate radiation dose on patients in interventional radiological(IVR) procedures classified by each procedure, and aid as data for safety management. Fluroscopy time(F-time), dose area product(DAP) and number of acquired images from each kind of procedure was checked. Non-vascular procedures showed low value, and vascular procedure showed high value in all procedures except in IVC filter. F-time was longest in EVAR, which showed also the highest DAP value of all procedures. DAP-rate showed high value in TACE. By this result, we attempt to establish standard guideline of radiation dose on patients in IVR procedure.