Radiation Dose to the Operator during Vertebroplasty: Prospective Comparison of the Use of 1-cc Syringes versus an Injection Device

Abstract

BACKGROUND AND PURPOSE: Percutaneous vertebroplasty procedures require relatively long durations of fluoroscopic guidance, which might lead to substantial radiation dose to operators. Specialized injection devices have been proposed to limit operator exposure. Our purpose was to compare the radiation dose to the operator’s hands during vertebroplasty when using 1-cc syringes versus that when using an injection device.

METHODS: Radiation dosimeters were worn on the left wrist during 39 vertebroplasty injection procedures in 25 patients. Cases were alternated between the use of 1-cc syringes (19 procedures) and the use of an injection device (20 procedures). For each procedure, one dosimeter was worn throughout the procedure, both during needle placement and injection, and a second dosimeter was worn during the injection phase only. Mean doses for the whole case and mean doses for the injection procedure alone were compared between groups.

RESULTS: Mean whole case dose was 128 ± 161 mrem (range, 0–660 mrem) for the 1-cc syringe group versus 98 ± 90 mrem (range, 0–340 mrem) for the injection device group (P = .23). Mean dose during injection was 100 ± 145 mrem (range, 0–660 mrem) for the 1-cc syringe group versus 55 ± 43 mrem (range, 0–130 mrem) for the injection device group (P = .09). Three of 19 1-cc syringe cases yielded zero dose, compared with four of 20 injection device cases. Duration of injection was markedly different between groups, with mean injection times of 4.2 and 7.5 min for 1-cc syringe and injection device cases, respectively (P < .00002). Mean injection dose per minute of lateral fluoroscopy was 23.6 and 7.3 mrem for the 1-cc syringe and injection device groups, respectively (P = .002).

CONCLUSION: The use of an injection device significantly decreased the radiation dose to the operator’s extremity per unit time of injection. However, total dose per injection was equivalent between groups because of significantly longer injection duration for the injection device cohort.