Abstract
Introduction
Medical Exposure Directive of the European Commission, 97/43/Euratom recommended setting-up local national diagnostic reference levels (DRLs) for the most common radiological examinations in order to comply with the law and to maintain safe clinical practice. There are no guidelines for spinal diagnostic and therapeutic procedures. The aims of this study were to evaluate local radiation doses & screening times for diagnostic spinal blocks, to look at PACS image intensifier films for diagnostic representation and to assess the accuracy of data in IR(ME) document.
Materials and Methods
Between 1/01/2009 and 15/07/2010, all spinal blocks done under care of three spinal surgeons (LB/NC/AAC) were reviewed. Images revisited on PACS for confirmation. We reviewed 229 patients (included single & two levels nerve root blocks, facet joint and lysis blocks). Data were collected with regard to radiation dose, screening times, third-quartile values used to establish DRLs, IR(ME) documentation and PACS fluoroscopic image documentation.
Results
Third quartile single level NRB DAP (Dose area product) was 111.5 cGyCm2. Single level NRB screening time was mean-0.13, third quartile-0.2 min. Nerve specific dosimetry included L5 nerve (0.2 min; 119cGyCm2) and S1 nerve (0.2 min; 118.7cGyCm2). Mean ‘Click: Block ratio’ (last click for PACS/Block) was 22.4 (SD=7.05, range 10 to 48). Local fluoroscopic documentation was 87.2%.
Conclusions
There are no national standards in radiation dosimetry for diagnostic spinal blocks. We recommend that all spinal units in the UK should evaluate their own DRLs to help establish national guidelines for fluoroscopy-guided spinal procedures. Representative fluoroscopic image documentation on PACS was 87% locally. It is a joint responsibility of radiographer & operating surgeon to make it 100% to reduce medicolegal risks.
