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Review
. 2025 Jan 6;29(1):12.
doi: 10.1007/s11916-024-01327-2.

Influence of Obesity, Race and Gender on Radiation Exposure for Epidural Procedures

Laxmaiah Manchikanti  1   2   3 , Alan D Kaye  4   5   6 , Mahendra R Sanapati  1   7 , Vidyasagar Pampati  1 , Sahar Shekoohi  8 , Joshua A Hirsch  9
Affiliations
Review

Influence of Obesity, Race and Gender on Radiation Exposure for Epidural Procedures

Laxmaiah Manchikanti et al. Curr Pain Headache Rep. .

Abstract

Purpose of review: This retrospective, case controlled, comparative evaluation review of radiation exposure during epidural procedures in interventional pain management assessed variations in radiation exposure based on obesity, race, and gender.

Recent findings: Numerous publications have shown increasing radiation exposure based on body mass index (BMI). However, the influence of race and gender have not been studied. A recent study assessing radiation exposure for epidural procedures with mandated 2 views, compared to a single view or optional 2 views, showed an increase in exposure time of 21%, with radiation dose increases of 133%. The influence of obesity, has been studied, but potential influence of race, and gender on radiation exposure for epidural procedures has not been studied. The present review shows a prevalence of total obesity with BMI of 30 or above of 50.9%, with a higher prevalence in patients below the age of 45, female gender, and African Americans. Mean fluoroscopy time and dose increased significantly from 6.9 s to 0.925 milligray (mGy) for all epidural procedures for those who are underweight to 10.0 s and 6.7 mGy for those with Class 3 obesity above BMI of 40. However, after adjusting for body mass index, no significant differences were noted in race for both fluoroscopy time and radiation dose across multiple epidural procedures. Fluoroscopy time and radiation dose increased in males in cervical interlaminar and lumbar transforaminal procedures.

Keywords: Gender; Obesity; Race; Radiation dose; Radiation exposure time; Spinal interventional procedures.

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Conflict of interest statement

Declarations. Conflict of Interest: Alan D. Kaye served as an editor for Current Pain and Headache Reports. Dr. Hirsch is a consultant for Medtronic, Relievant, and Sanofi. He is a grant supported Senior Affiliate Research Fellow at the Neiman Policy Institute. Human and Animal Rights and Informed Consent: This article does not contain any studies with human or animal subjects performed by any of the authors.

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