Fluoroscopy-guided versus CT-guided Lumbar Steroid Injections: Comparison of Radiation Exposure and Outcomes

Purpose: To compare the radiation exposure for participants and interventionalists as well as participant outcomes between fluoroscopy-guided versus CT-guided lumbar spinal injections. Materials and Methods: This prospective, nonrandomized observational study included 1446 participants (mean age, 60.6 years; range, 18-91 years) who received transforaminal epidural injections or facet joint injections under fluoroscopic or CT guidance between October 2009 and April 2016. Effective doses were estimated by conversion from dose-area product for fluoroscopy-guided injections and dose-length product for CT-guided injections. Radiation exposure for interventionalists was measured with dosimeters at the body and wrist. The Patient Global Impression of Change (PGIC) scale was used to assess clinical participant outcomes at 1 day, 1 week, and 1 month after lumbar spine injections. Student t and chi(2) tests were used for statistical analysis. Results: The mean effective participant dose for fluoroscopy-guided lumbar transforaminal epidural injections was 0.24 mSv +/- 0.22, compared with 0.33 mSv +/- 0.10 for CT-guided injections (P < .003). The mean effective participant dose for fluoroscopy-guided lumbar facet joint injections was 0.10 mSv +/- 0.11, compared with 0.33 mSv +/- 0.13 for CT-guided injections (P < .001). Radiation exposure for the interventionalist was higher during fluoroscopy-guided compared with CT-guided lumbar transforaminal epidural injections (body: 0.42 x 10(-3) mSv +/- 0.99 vs 0.11 x 10(-3) mSv +/- 0.44, P < .03; wrist: 1.44 x 10(-3) mSv +/- 2.69 vs 0.14 x 10(-3) mSv +/- 0.55, P < .001). Radiation exposure of the wrist for the interventionalist was higher during fluoroscopy-guided compared with CT-guided lumbar facet injections (0.46 x 10(-3) mSv +/- 0.93 vs 0.06 x 10(-3) mSv +/- 0.24, respectively; P < .006). Clinical participant outcomes as determined with the PGIC scale did not differ between fluoroscopy-guided and CT-guided injections (P = .15-.96). Conclusion: Radiation exposure in fluoroscopy-guided lumbar spinal injections was lower for participants and higher for physicians when compared with CT-guided injections; however, no associations were observed between clinical participant outcomes and type of imaging-guided injection technique at all evaluated time points. (C) RSNA, 2018