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Fluoroscopy Time and Radiation Dose: Comparison between Transforaminal and Caudal Epidural Steroid Injections 2012

Interventional Spine

Seon-Jeong, Kim, MD
Min Hee, Lee, MD, Non ASSR Member
Hye Won, Chung, MD, Non ASSR Member
Sang Hoon, Lee, MD, Non ASSR Member
Myung Jin, Shin, MD, Non ASSR Member



Techniques of lumbosacral epidural steroid injection (ESI) include transforaminal and caudal approaches under fluoroscopic guidance. We compared fluoroscopy time and radiation dose of each technique during the ESI.

Methods & Materials

Total 228 patients (82 males, 146 females; mean age, 63.3 years) who received lumbosacral ESI were included. Transforaminal ESI was performed in 181 patients (68 males, 113 females; mean age, 61.3 years) at the level of L2-4 in 29, of L5 in 123 and of S1 in 29. Caudal approach was done in 47 patients (16 males, 31 females; mean age, 69.7 years). All ESIs were conducted under a single plane fluoroscopic guidance by one musculoskeletal radiologist with 16 year-experience in performing spinal interventions. Fluoroscopic settings were 16 ms of pulse width, 15 p/s of pulse rate at 70 kv. Fluoroscopy time (FT) and dose-area product (DAP) were recorded in all patients. FT and DAP were correlated at each approach and compared between both approaches. Statistical analyses were performed using Pearson correlation, linear regression correlation (Stata version 11; Stata Corp LP, College Station, TX, USA). All reported P values were 2-tailed, and statistical significance was set at P <0.05.


FT ranged from 11 to 161 sec in transforaminal ESI (mean, 36.0 sec) and ranged from 4 to 78 sec (mean, 18.2 sec) in caudal ESI. DAP ranged from 3.02 to 1048.2 μGyâ