• Edward Braun, Andrew M Sack, Dawood Sayed, Smith Manion, Brian Hamm, Michael Brimacombe, Michael Tollette, Talal W Khan, Walter Orr, and Andrea Nicol.
• University of Kansas Medical Center, Kansas City, KS.
• Pain Physician. 2018 Jan 1; 21 (1): 53-60.

BackgroundFluoroscopy-guided lumbar transforaminal epidural steroid injections (L-TFESI) result in radiation exposure that carries risks to patients, physicians, and procedural staff.ObjectiveWe aim to evaluate the feasibility of using pulsed fluoroscopy to safely reduce radiation exposure during L-TFESI.Study DesignThis is a prospective, double-blind, randomized controlled trial.SettingThis study took place in a single-center, academic, outpatient interventional pain management clinic.MethodsPatients undergoing L-TFESI were randomly assigned to either continuous mode fluoroscopy (high-dose), pulsed fluoroscopy with 8 pulses per second (medium-dose), or pulsed fluoroscopy with one pulse per second (low-dose). Data on radiation doses and other clinical and demographic factors were also collected.ResultsIn total, 231 cases were analyzed in the high-dose group (n = 81), medium-dose group (n = 72), and low-dose group (n = 78). Mean radiation effective dose (µSv) was 121 in the high-dose group, 57.9 in the medium-dose group, and 34.8 in the low-dose group (P < 0.001). The incidence of inadequate image quality in the pulsed groups was 6% (9/150). The body mass index (BMI, mean ± SD) was significantly higher in patients with inadequate image quality (37.3 ± 7.2) than with adequate quality (30.5 ± 7.2, P = 0.005).LimitationsRadiation doses were measured using the meter on C-arm fluoroscopes rather than by direct measurement.ConclusionsThe use of pulsed fluoroscopy during L-TFESI resulted in radiation dose reduction of up to 72.1% without causing any significant adverse events. Pulsed fluoroscopy should be considered as an initial fluoroscopic setting for L-TFESI to reduce radiation exposure.Key WordsRadiation, epidural, fluoroscopy, injection, exposure, pulse.

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