Comparison of Radiation Doses for Different Techniques in Fluoroscopy-Guided Lumbar Facet Medial Branch Blocks: A Retrospective Cohort Study

Abstract

Chronic lumbar facet pain is commonly treated with fluoroscopy-guided facet medial branch blocks (FMBBs). However, the associated radiation exposure of both patients and clinicians is a growing concern. This study aimed to compare radiation doses and fluoroscopy times between two techniques, i.e., oblique and posterior-anterior (PA) fluoroscopic approaches, while also examining the impact of physician experience on these metrics. A retrospective analysis was conducted on 180 patients treated at Mersin University Hospital Pain Clinic between January and July 2024. Patients were divided into two groups: 90 received the oblique technique (Group O) and 90 received the AP technique (Group A). Radiation dose and fluoroscopy time data were collected for each patient. The AP technique was associated with significantly lower radiation doses (mean 66 mGy) and shorter fluoroscopy times (mean 28 s) compared to the oblique technique (mean radiation dose of 109 mGy and fluoroscopy time of 46 s) (p < 0.001). Physician experience also influenced these outcomes, with more experienced physicians consistently using less radiation. The AP technique should be considered for FMBBs, as it reduces radiation exposure while maintaining procedural efficiency, highlighting the importance of experience in optimizing outcomes.

Keywords: fluoroscopy; lumbar facet medial branch blocks; radiation exposure; radiation safety.

Figure 1

Patient flow chart.

Figure 2

Oblique technique FMBB, “Scottie dog” view.

Figure 3

(A): Anterior–posterior (AP) technique FMBB fluoroscopy view. (B) This image was taken to ensure that the needle was in the targeted “Scottie dog” area.