1. 2003;6;301-305Effectiveness of Protective Measures in Reducing Risk of Radiation Exposure in Interventional Pain Management: A Prospective Evaluation
   An Original Contribution
   Laxmaiah Manchikanti, MD, Kim A. Cash, RT, Tammy L. Moss, RT, and Vidyasagar Pampati, MSc.

It is estimated that over 50% of approximately 4 million interventional procedures performed annually in the United States are performed utilizing fluoroscopy. Fluoroscopy offers validity to interventional techniques by providing precise localization of anatomic target areas and facilitating accurate delivery of injectate. Exposure to ionizing radiation is an unavoidable consequence while performing fluoroscopic procedures. The primary source of radiation to the physician during interventional procedures is from scatter reflected back from the patient.

Multiple investigators have prospectively evaluated radiation exposure to the physician performing fluoroscopically guided interventional procedures in various settings, with varying results.

This prospective controlled study was undertaken to evaluate scatter radiation risk of whole body exposure and protective measures to reduce scatter radiation in the upper and lower parts of the body in fluoroscopically guided interventional techniques. Five hundred consecutive patients, undergoing interventional procedures, in an ambulatory surgery setting were studied. The mode utilized varied from pulsed-imaging to continuous fluoroscopic imaging. All the protective measures were incorporated, including lead shielding from the table to the floor covering the entire area of the beam. Scatter radiation exposure was monitored in 5 areas with 3 badges inside the apron and 2 outside the apron.

Results of this study showed an average exposure per patient of 8.9 + 0.4 seconds and per procedure of 4.9 + 0.11 seconds. Scatter radiation exposure was higher outside the lead aprons compared to inside the lead aprons. Scatter radiation exposure at groin level was similar with or without lead shielding from the table to the floor.

Keywords: Interventional pain management, fluoroscopy, C-arm, radiation exposure, radiation toxicity, scatter radiation, maximum permissible dose, as low as reasonably achievable (ALARA)