Pain medicine (Malden, Mass.) · 2019
Improved Dose Estimates for Fluoroscopically Guided Lumbar Epidural Injections.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Mann Steve D, Joshi Anand, Shonyo Megan, Wells Jered R, Hoye Jocelyn, Agasthya Greeshma, Reiman Robert, Samei Ehsan
Аннотация
OBJECTIVE: The goal of the study was to determine the potential impact of system inaccuracies and table attenuation on fluoroscope-reported dose values.
DESIGN: An Institutional Review Board-approved study was conducted to collect detailed acquisition and patient exposure data for fluoroscopy-guided lumbar epidural injections.
BACKGROUND: System-reported dosimetry values, especially the air Kinetic Energy Released per unit MAss and dose-area product metrics, are routinely used for estimating the radiation burden to patients undergoing fluoroscopy-guided procedures. However, these metrics do not account for other factors, such as acquisition geometry, where the table may attenuate a substantial fraction of the x-ray intensity, and system dosimetry inaccuracies, which are only required to be accurate within ±35%.
METHODS: Acquisition data from 46 patients undergoing fluoroscopy-guided lumbar epidural injections were collected to better estimate the true incident dose-area product. Gantry angles, x-ray technique factors, and field sizes were collected to characterize each procedure. Additionally, the fluoroscope dosimetry accuracy and table attenuation properties were evaluated as a function of kVp to generate the correction factors necessary for accurate dosimetry estimates.
RESULTS: The system-reported values overestimated the total patient entrance dose-area product by an average of 34% (13-44%). Errors may be substantially higher for systems with less accurate fluoroscopes or more anterior-posterior projections. Correcting system-reported dosimetry values for systematic inaccuracies and variability can substantially improve fluoroscopic dose values.
CONCLUSIONS: Including corrections for system output inaccuracies and acquisition factors such as table attenuation is necessary for any reliable assessment of radiation burden to patients associated with fluoroscopy-guided procedures.
DESIGN: An Institutional Review Board-approved study was conducted to collect detailed acquisition and patient exposure data for fluoroscopy-guided lumbar epidural injections.
BACKGROUND: System-reported dosimetry values, especially the air Kinetic Energy Released per unit MAss and dose-area product metrics, are routinely used for estimating the radiation burden to patients undergoing fluoroscopy-guided procedures. However, these metrics do not account for other factors, such as acquisition geometry, where the table may attenuate a substantial fraction of the x-ray intensity, and system dosimetry inaccuracies, which are only required to be accurate within ±35%.
METHODS: Acquisition data from 46 patients undergoing fluoroscopy-guided lumbar epidural injections were collected to better estimate the true incident dose-area product. Gantry angles, x-ray technique factors, and field sizes were collected to characterize each procedure. Additionally, the fluoroscope dosimetry accuracy and table attenuation properties were evaluated as a function of kVp to generate the correction factors necessary for accurate dosimetry estimates.
RESULTS: The system-reported values overestimated the total patient entrance dose-area product by an average of 34% (13-44%). Errors may be substantially higher for systems with less accurate fluoroscopes or more anterior-posterior projections. Correcting system-reported dosimetry values for systematic inaccuracies and variability can substantially improve fluoroscopic dose values.
CONCLUSIONS: Including corrections for system output inaccuracies and acquisition factors such as table attenuation is necessary for any reliable assessment of radiation burden to patients associated with fluoroscopy-guided procedures.