Dose area product values of fluoroscopically guided pain management procedures: Comparison of a Belgian teaching hospital with national diagnostic reference levels

Abstract

In 2011, national diagnostic reference levels (DRLs) were proposed for pain management fluoroscopic procedures in Belgium. The primary goal of this work is to compare the dose area product values (DAP) recorded at the Saint-Luc University Hospital to these DRLs. From 2012 to 2015, 7664 interventional pain management procedures (4740 epidural, 2097 medial branch and 807 transforaminal infiltrations) were performed. Uni/multivariable analyses were done regarding the influence of different factors. The fluoroscopy duration and the DAP are lower to the DRLs (p < 0.001). From 7644 procedures' DAP, 1431 (18.7%) were higher than the DRLs: 1397 epidural (29.5%), 16 medial branch (0.8%) and 18 transforaminal infiltrations (2.2%) (p < 0.001 between procedures). The main factor that significantly modifies DAP, as duration, is the practitioner. Additionally, we obtained [IQR: 25-75] values for epidural [0.0174-0.055 mGy m2], medial branch block [0.0194-0.0472] and transforaminal infiltrations [0.0499-0.1067 mGym2] (p < 0.05 vs. DRLs, respectively, 0.05, 0.25 and 0.3 mGym2). Systematic use of contrast confirmation significantly increases DAP (p < 0.001). This retrospective analysis shows differences in DAP, mainly driven by the practitioner. This suggests the existence of modifiable factors. Programs aiming to determine these factors to reduce this DAP are justified.