Korean J Pain.  2020 Jan;33(1):73-80. 10.3344/kjp.2020.33.1.73.

Radiation exposure to the eyes and thyroid during C-arm fluoroscopy-guided cervical epidural injections is far below the safety limit

• Choi EJ
• Go G
• Han WK
• Lee PB

• KMID: 2506646
• DOI: http://doi.org/10.3344/kjp.2020.33.1.73

Abstract

Background
The aim of this study was to evaluate radiation exposure to the eye and thyroid in pain physicians during the fluoroscopy-guided cervical epidural block (CEB).
Methods
Two pain physicians (a fellow and a professor) who regularly performed Carm fluoroscopy-guided CEBs were included. Seven dosimeters were used to measure radiation exposure, five of which were placed on the physician (forehead, inside and outside of the thyroid protector, and inside and outside of the lead apron) and two were used as controls. Patient age, sex, height, and weight were noted, as were radiation exposure time, absorbed radiation dose, and distance from the X-ray field center to the physician.
Results
One hundred CEB procedures using C-arm fluoroscopy were performed on comparable patients. Only the distance from the X-ray field center to the physician was significantly different between the two physicians (fellow: 37.5 ± 2.1 cm, professor: 41.2 ± 3.6 cm, P = 0.03). The use of lead-based protection effectively decreased the absorbed radiation dose by up to 35%.
Conclusions
Although there was no difference in radiation exposure between the professor and the fellow, there was a difference in the distance from the X-ray field during the CEBs. Further, radiation exposure can be minimized if proper protection (thyroid protector, leaded apron, and eyewear) is used, even if the distance between the X-ray beam and the pain physician is small. Damage from frequent, low-dose radiation exposure is not yet fully understood. Therefore, safety measures, including lead-based protection, should always be enforced.

Keyword

Anesthesia; Epidural; Cervical Vertebrae; Chronic Pain; Eye; Fluoroscopy; Physicians; Protection; Radiation; Thyroid Gland

Figure

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  Fig. 1 The cervical epidural block (CEB) technique. (A) Lateral view of a pain physician performing a CEB. (B) Anterior view of a pain physician performing a CEB.

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  Fig. 2 Thermoluminescent dosimeters were placed on the forehead (A), outside the thyroid protector (B), inside the thyroid protector (C), inside the apron (D), and outside the apron (E).

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  Fig. 3 Measurement of the distance (A) between the center of the X-ray field (B) and the physician. The distance between the X-ray beam and the physician was measured during imaging after needle manipulation.

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  Fig. 4 Annual equivalent dose (approximately 600 cases) was calculated from 2-month (100 cases) exposure data, as measured using thermoluminescent dosimeters. Annual maximum permissible radiation doses set by the International Commission on Radiological Protection are 500 and 20 mSv for the thyroid and crystalline lens, respectively. In: inside, Out: outside.

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