Decreased patient exposure to ionizing radiation during interventional rheumatology procedures after optimization of protection

Abstract

Objectives: To decrease radiation exposure of patients undergoing interventional rheumatology procedures, without adversely affecting quality of care.

Methods: The radiation dose received, assessed by the dose-area product (DAP), was measured during 283 intraarticular injections performed under fluoroscopic guidance between May and July 2013. Then, three steps were taken to decrease patients' radiation exposure: a copper filter was added, the anti-scatter grid was removed, and exposure cell sensitivity was set at the highest value. DAP was measured during 158 intraarticular injections performed in 2014 with these measures in place.

Results: Mean DAP before optimization was 175μGray·m² during facet joint injections (n=4) and 43μGray·m² during hip injections but was less than 20μGray·m² for injections into the shoulders (15.7μGray·m²), ankles (7.7μGray·m²), wrists (3.7μGray·m²), and fingers (3.3μGray·m²). After optimization, DAP decreased markedly for all injection sites, by 52% (shoulders) to 87% (facet joints, 22.7μGray·m²). Decreases occurred at all three steps of the procedure, i.e., patient installation, injection, and last image hold. Exposure during facet joint injections varied from 84 (54.5-108.5) μGray·m² when body mass index (BMI) was <25kg/m² to 228.9 (161.3-340.4)μGray·m² when BMI was>30kg/m².

Conclusion: Simple technical changes translate into large decreases in patient radiation exposure during fluoroscopically-guided injections, particularly at the facet joints and in obese patients.

Keywords: Interventional rheumatology; Optimization of protection; Patient radiation exposure; Radioprotection.