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J Spinal Disord Tech. 2014 Feb;27(1):E37-40. doi: 10.1097/BSD.0b013e31829eb80f.

Radiation exposure for fluoroscopy-guided lumbosacral epidural steroid injections: comparison of the transforaminal and caudal approaches.

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  • 1*Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul †Department of Radiology, Inje University Haeundae Paik Hospital, Busan ‡Department of Radiology, Gachon University Gil Hospital, Incheon, South Korea.



A retrospective investigation.


We evaluated and compared the radiation exposure caused by using the fluoroscopy-guided transforaminal and caudal approaches of lumbosacral epidural steroid injection (ESI).


Only a few studies focused on the radiation exposure to patients who underwent lumbosacral ESI for pain management.


A total of 228 patients (83 males, 145 females; mean age, 63.3 y) who received lumbosacral ESI were included. Transforaminal ESI was performed in 181 patients (67 males, 114 females; mean age, 61.3 y) and caudal ESI was used in 47 patients (16 males, 31 females; mean age, 69.7 y). All ESIs were performed under a single-plane fluoroscopic guidance by 1 musculoskeletal radiologist. The kerma-area product (KAP) and fluoroscopy time were recorded in all patients. Both measurements were correlated and compared for each approach.


KAP was 3.02-1048.2 μGy m (mean, 101.7 μGy m; median, 67.8 μGy m) for transforaminal ESI and 16.0-604.5 μGy m (mean, 101.8 μGy m; median, 54.6 μGy m) for caudal ESI. The fluoroscopy time was 11-161 seconds for transforaminal ESI (mean, 36.0 s; median, 29 s) and 4-78 seconds (mean, 18.2 s; median, 13 s) for caudal ESI. KAP and fluoroscopy time were positively correlated for each approach (P<0.001). Fluoroscopy time was significantly longer for transforaminal ESI (correlation coefficient=-0.77, P=0.000). After correction for the fluoroscopy time, KAP was less in transforaminal ESI than in caudal ESI (correlation coefficient=0.74, P=0.000).


The longer the fluoroscopy time, the greater the KAP in both transforaminal and caudal ESIs. The fluoroscopy time for transforaminal ESI was longer than that for caudal ESI. However, KAP of transforaminal ESI was less than that of the caudal ESI, after being corrected for the length of fluoroscopy time.

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