Decreased patient exposure to ionizing radiation during interventional rheumatology procedures after optimization of protection

ObjectivesTo decrease radiation exposure of patients undergoing interventional rheumatology procedures, without adversely affecting quality of care.MethodsThe radiation dose received, assessed by the dose-area product (DAP), was measured during 283 intraarticular injections performed under fluoroscopic guidance between May and July 2013. Then, three steps were taken to decrease patients' radiation exposure: a copper filter was added, the anti-scatter grid was removed, and exposure cell sensitivity was set at the highest value. DAP was measured during 158 intraarticular injections performed in 2014 with these measures in place.ResultsMean DAP before optimization was 175 μGray·m2 during facet joint injections (n = 4) and 43 μGray·m2 during hip injections but was less than 20 μGray·m2 for injections into the shoulders (15.7 μGray·m2), ankles (7.7 μGray·m2), wrists (3.7 μGray·m2), and fingers (3.3 μGray·m2). After optimization, DAP decreased markedly for all injection sites, by 52% (shoulders) to 87% (facet joints, 22.7 μGray·m2). Decreases occurred at all three steps of the procedure, i.e., patient installation, injection, and last image hold. Exposure during facet joint injections varied from 84 (54.5-108.5) μGray·m2 when body mass index (BMI) was < 25 kg/m2 to 228.9 (161.3-340.4) μGray·m2 when BMI was > 30 kg/m2.ConclusionSimple technical changes translate into large decreases in patient radiation exposure during fluoroscopically-guided injections, particularly at the facet joints and in obese patients.