Evaluating Trends in Radiation Dose During Fluoroscopic Lumbar Puncture

Introduction Minimizing patient radiation exposure when performing procedures under fluoroscopy is important for ensuring patient safety. Our primary objective in this quality improvement study was to assess trends in fluoroscopy time during image-guided lumbar punctures. In addition, we assessed the demographic and clinical factors that influenced fluoroscopy time during these procedures. Methods Data on patient body mass index (BMI), patient age, and sedation method were obtained. In addition, information on the performing healthcare provider and date of procedure were obtained in order to derive the number of lumbar punctures previously performed by individual providers at the time of the procedure. Data were analyzed using ANOVA and a p<.05 was considered significant. Results A total of 370 fluoroscopy-guided lumbar punctures performed by resident physicians, attending physicians, and physician assistants were reviewed. A statistically significant difference in mean fluoroscopy time was identified in patients of differing ages with older age being associated with higher fluoroscopy times (p<0.01). No significant difference existed regarding patient BMI (p=0.16) or method of sedation (p=0.84) when compared to mean fluoroscopy time. A statistically significant decrease in fluoroscopy time was observed as more lumbar punctures were performed by clinicians (p=0.02). Conclusions Significant increases in mean fluoroscopy times were observed in older patients, which may be secondary to degenerative changes of the spine making access to the thecal sac more difficult. No significant difference in mean fluoroscopy time was identified in regards to patient BMI or method of sedation. Using a formula derived from our data describing decreases in fluoroscopy time based on the number of procedures performed, it may be possible to predict how many lumbar punctures need to be performed by new trainees in order to reach certain levels of proficiency.