You all probably remember my post a month or so ago asking about radiation exposure with all the pain management procedures done under the fluoroscope. In response, I know several of you also voiced your own concerns, so I'm hoping this follow-up post with the information I have come across will hopefully help us all minimize and manage our radiation exposure as best we can.
My PM doc has been amazing addressing my concerns about radiation exposure and he has taken steps with me to help minimize my exposure. First, it is important to understand that the fluroscope is an amazing tool that makes pain management procedures safer and more accurate, so the radiation is necessary but there are steps that we can take to try to minimize our exposure:
1) Pulsed fluoroscopy should be used, when possible. I always ask the radio technologist to make sure they are using pulsed rather than continuous fluoroscopy because this is one factor that makes a huge difference in the dose of radiation. With injections it is usually standard to do pulsed fluoroscopy, but it doesn't hurt to ask to make sure.
2) Ask the radio technologist to refrain from taking any images until the physician is in the room. A lot of radio technologist like to take a few images to get everything lined up prior to the physician entering the room, but this can amount to unnecessary radiation since nobody is viewing the images being taken. It makes more sense to wait and let the doctor direct the images being taken to line everything up prior to the procedure since most doctors like to line things up themselves anyways and rarely use images taken prior to the procedure. I have had radio technologists argue with me about this, but ultimately I feel like as a patient it is ok to ask them to wait if it could potentially decrease the total radiation dose.
3) If only a small section of your back needs to be viewed, request that they shield the other parts of your body. For example, for most epidurals they only need to see a few of the vertebrae, so they can put lead on you above and below where they need to see. The radiation with C-arm fluoroscopy comes from the table (I never knew that) and is caught by the filter in the C-arm. To shield me, what my doctor does is drape lead aprons over the fluoroscopy table that I lay on top of in areas that he does not need to view. For example, for an epidural done at L5 they lay an apron on the table that starts around L2 and goes up to cover my chest, and they also position one under my pelvis that goes down to cover part of my legs. This leaves the area from the top of my sacrum to L3ish exposed where they need the X-rays to see, while the rest of me is shielded laying on top of the lead. It's a little bit of trouble to position the lead shields on the table underneath you so that they aren't covering anything that needs to be seen, but my doctor has been absolutely amazing in working with me on this and hopefully your physicians will also be willing to take this extra step to help minimize your radiation exposure.
These are the steps I now take every time I go under the fluoroscope to do what I can as a patient to minimize my exposure. I think all of us that go under the fluoroscope on a regular basis should be asking our doctors how to minimize our radiation exposure. My doctor was compassionate enough to take the time to really think it through and come up with using the lead shields, and maybe your doctors could also use this method or come up with other ways to help minimize radiation exposure. It can be intimidating to have that conversation and I have had some docs that dismiss me as crazy for worrying about the radiation, but I am so glad I brought it up with my PM doc because I really feel like these small steps are helping to reduce my radiation exposure. If nothing else, it gives me peace of mind to know we are taking every step possible to minimize the radiation risk.
Another benefit of having that conversation is that it should make your doctor and radio technologist more aware of radiation exposure during your procedure, and if they are more conscious of radiation while doing the procedure it is possible that they would be more conservative in the amount that is used.
A final note is that I have searched and searched for info regarding the radiation dose for various interventional pain management procedures, but the data varies greatly depending on equipment, patient size, the doctor, and other factors. I have been reassured that the exposure is low, especially relative to other procedures done under the fluoroscope (and I am guessing that some of the FDA warnings about fluoroscopy are looking at cardiac procedures that can last 30-60 minutes, where as PM procedures are usually very quick).
I hope this information is helpful!