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. 2012:5:265-9.
doi: 10.2147/JPR.S34429. Epub 2012 Aug 13.

Radiation dose reduction in CT-guided sacroiliac joint injections to levels of pulsed fluoroscopy: a comparative study with technical considerations

Juraj Artner  1 , Balkan Cakir, Heiko Reichel, Friederike Lattig
Affiliations

Radiation dose reduction in CT-guided sacroiliac joint injections to levels of pulsed fluoroscopy: a comparative study with technical considerations

Juraj Artner et al. J Pain Res. 2012.

Abstract

Background: The sacroiliac (SI) joint is frequently the primary source of low back pain. Over the past decades, a number of different SI injection techniques have been used in its diagnosis and therapy. Despite the concerns regarding exposure to radiation, image-guided injection techniques are the preferred method to achieve safe and precise intra-articular needle placement. The following study presents a comparison of radiation doses, calculated for fluoroscopy and CT-guided SI joint injections in standard and low-dose protocol and presents the technical possibility of CT-guidance with maximum radiation dose reduction to levels of fluoroscopic-guidance for a precise intra-articular injection technique.

Objective: To evaluate the possibility of dose reduction in CT-guided sacroiliac joint injections to pulsed-fluoroscopy-guidance levels and to compare the doses of pulsed-fluoroscopy-, CT-guidance, and low-dose CT-guidance for intra-articular SI joint injections.

Study design: Comparative study with technical considerations.

Methods: A total of 30 CT-guided intra-articular SI joint injections were performed in January 2012 in a developed low-dose mode and the radiation doses were calculated. They were compared to 30 pulsed-fluoroscopy-guided SI joint injections, which were performed in the month before, and to five injections, performed in standard CT-guided biopsy mode for spinal interventions. The statistical significance was calculated with the SPSS software using the Mann-Whitney U-Test. Technical details and anatomical considerations were provided.

Results: A significant dose reduction of average 94.01% was achieved using the low-dose protocol for CT-guided SI joint injections. The radiation dose could be approximated to pulsed-fluoroscopy- guidance levels.

Conclusion: Radiation dose of CT-guided SI joint injections can be decreased to levels of pulsed fluoroscopy with a precise intra-articular needle placement using the low-dose protocol. The technique is simple to perform, fast, and reproducible.

Keywords: computed tomography; guided injections; low back pain; low-dose protocol; radiation dose; sacroiliac joint injection; sacroiliac joint pain.

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Figures

Figure 1
Figure 1
Preparation for SI joint injection. Based on the anatomic landmarks, the midline between the major trochanter and iliac crest is identified (A) and marked on the skin (B). The target laser of the scanner is brought into an overlapping position with the marked midline (C).
Figure 2
Figure 2
Bilateral CT-guided SI joint injection in low-dose protocol.
Figure 3
Figure 3
Demonstrations of image quality difference in conventional CT-guidance for spinal interventions (left) and low-dose CT (right).
Figure 4A
Figure 4A
Comparison of radiation doses of conventional CT-guidance, low-dose protocol, and fluoroscopy in SI joint injections. Abbreviation: CT, computer tomography.
Figure 4B
Figure 4B
Comparison of radiation doses of fluoroscopic- and low-dose CT-guided SI-joint injections. Abbreviation: CT, computer tomography.
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