• Bradly S Goodman, Charles T Carnel, Srinivas Mallempati, and Pooja Agarwal.
• Alabama Orthopedic, Spine & Sports Medicine Associates, Birmingham, AL, USA.
• Am J Phys Med Rehabil. 2011 Nov 1;90(11):908-12.

ObjectiveA practice improvement project was completed with the goal of reducing radiation exposure times in a busy spinal intervention practice through the use of "pulsed" and "low-dose fluoroscopy." The goal was to quantify the reduction in fluoroscopy exposure times with these modes.DesignExposure times were recorded for 316 patients undergoing spinal interventional procedures before and after the implementation of this project. Before implementation, 158 consecutive patients received spinal interventions with nonpulsed fluoroscopy on an Orthopedic Equipment Company 9800 and exposure times were recorded. After implementation of the practice improvement project, 158 consecutive patients received spinal interventions with pulsed and low-dose modes. Exposure times were then compared between these groups.ResultsPulsed and low-dose fluoroscopy modes reduced overall exposure times by 56.7% after implementation of the practice improvement project.ConclusionsThe use of pulsed and low-dose fluoroscopy in addition to lead shielding; increasing distance from the radiation source; collimation; limited use of magnification, boost, or digital subtraction; and proficiency with interventional techniques should be used to reduce radiation exposure in concordance with the principle of "as low as reasonably achievable."

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