1. 2013;16;E731-E738Fluoroscopy Procedure and Equipment Changes to Reduce Staff Radiation Exposure in the Interventional Spine Suite
   Observational Study
   Christopher Plastaras, MD, Malathy Appasamy, MD, Yusef Sayeed, MD, MEng, MPH, Coleen McLaughlin, RT, Jeremy Charles, MD, Anand Joshi, MD, MHA, Donald Macron, MD, and Bryan Pukenas, MD.

BACKGROUND: Fluoroscopic guided percutaneous interventional spine procedures are increasingly performed in recent years as they have been shown to be target specific and enhance patient safety. However, ionizing radiation has been associated with stochastic effects such as cancer and genetic defects as well as deterministic effects such as cataracts, erythema, epilation, and even death. These are dose related, and hence, measures should be taken to minimize radiation exposure to patients and health care personnel to reduce these adverse effects.

OBJECTIVE: A risk reduction project was completed with the goal of reducing effective doses to the staff and patients in a university-based spinal interventional practice. Effective dose reduction to the staff and patients was hypothesized to occur with technique and equipment changes in the procedure suite. The goal of this study was to quantify effective dose rates to staff before and after interventions.

STUDY DESIGN: Retrospective study comparing descriptive data of effective dose to the health care staff before and after implementation of a combination of technique and equipment changes.

METHODS: Technique changes from pre to post intervention period included continuous needle advancement under continuous fluoroscopic controlled by the interventional physician to intermittent needle advancement under pulsed fluoroscopic controlled by the radiology technician. Equipment changes included circumferential lead drape skirt around the procedure table and use of mobile transparent lead barriers on both sides of the procedure table.
Effective dose exposure measured in Millirem (mrem) from the radiation dosimetry badges for pre-intervention (February 2009 through June 2009) and post-intervention (November 2009 through March 2010) periods were examined through monthly radiation dosimetry reports for the fluoroscopy suite staff.

RESULTS: A total of 685 interventional procedures were performed in the pre-intervention period and 385 in the post-intervention period. The median cumulative mrem (interquartile range) for all staff combined in the pre-intervention period was 71 (28,75) and post-intervention period was 1 (0,3). The median mrem per procedure was significantly higher in the pre-intervention group 0.46 (0.36, 0.54) compared to post-intervention 0.01 (0.0.03); P < 0.01. The percentage reduction in overall effective dose per procedure to all staff was 97.3%.

LIMITATIONS: Observational study, multiple radiation reduction interventions confound the individual effects of each intervention’s effective dose

CONCLUSIONS: Spinal injection technique and equipment changes in the procedure suite significantly reduced the rate of effective dose to the clinical staff.