PT  - JOURNAL ARTICLE
AU  - Miller, T.S.
AU  - Fruauff, K.
AU  - Farinhas, J.
AU  - Pasquale, D.
AU  - Romano, C.
AU  - Schoenfeld, A.H.
AU  - Brook, A.
TI  - Lateral Decubitus Positioning for Cervical Nerve Root Block Using CT Image Guidance Minimizes Effective Radiation Dose and Procedural Time
AID  - 10.3174/ajnr.A3158
DP  - 2013 Jan 01
TA  - American Journal of Neuroradiology
PG  - 23--28
VI  - 34
IP  - 1
4099  - http://www.ajnr.org/content/34/1/23.short
4100  - http://www.ajnr.org/content/34/1/23.full
SO  - Am. J. Neuroradiol.2013 Jan 01; 34
AB  - BACKGROUND AND PURPOSE: Cervical steroid injections are a minimally invasive means of providing pain relief to patients with cervical radiculopathy. CT guidance offers many potential advantages. We developed a technique with the patient in the lateral position with a lateral needle trajectory to minimize the required needle depth from skin to target and a near-vertical needle trajectory. The aim of this study was to analyze the cohort for complications, procedural time, and effective radiation dose. MATERIALS AND METHODS: This was a retrospective evaluation of a single-center patient cohort. PACS images from the procedures were reviewed for needle depth, procedural time, and CTDIvol. An anatomically relevant conversion factor was used to calculate the effective dose. RESULTS: One hundred sixteen cases from 110 patients were identified. The average patient age was 55 years. There were no complications. In 50% of cases, C5–6 was targeted. The average time was 6 minutes, and the average effective radiation dose, 0.51 mSv (0.21–2.56 mSv). Needle-insertion length from the skin to the target was highly correlated with a need for >3 needle repositioning adjustments and scan series (ρ = 0.52, P < .001) and increased procedural time (ρ = 0.42, P < .001). The angle of needle insertion relative to the floor was significantly correlated with an increased number of needle adjustments for depths >25 mm and a longer procedural time (ρ = 0.29, P = .01) but not for depths <25 mm. CONCLUSIONS: The lateral patient position with CT guidance is safe and allows use of a short needle in a vertical trajectory. This reduces the number of needle adjustments and imaging series to provide a short procedural time with a low effective radiation dose from the procedure. CSIcervical epidural steroid injectionsCTDIvolCT dose index volumeDLPdose-length productEDeffective dose