Radiation dose and intra-articular access: comparison of the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections

• Published in: Skeletal radiology 2016-03, Vol.45 (3), p.367-373
• Main Authors: Huang, Ambrose J., Balza, Rene, Torriani, Martin, Bredella, Miriam A., Chang, Connie Y., Simeone, Frank J., Palmer, William E.
• Format: Article
• Language: English
• Subjects: Anesthetics - administration & dosage; Arthralgia - diagnostic imaging; Arthralgia - drug therapy; Arthrography - methods; Comparative analysis; Female; Fluoroscopy - methods; Humans; Imaging; Injections, Intra-Articular - methods; Injections, Intralesional - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Nuclear Medicine; Orthopedics; Pathology; Privacy, Right of; Radiation; Radiation Dosage; Radiation Exposure - analysis; Radiation Exposure - prevention & control; Radiation Protection - methods; Radiography, Interventional - methods; Radiology; Reproducibility of Results; Retrospective Studies; Scientific Article; Sensitivity and Specificity; Tarsal Joints - diagnostic imaging
• ISSN: 0364-2348; 1432-2161
• DOI: 10.1007/s00256-015-2300-8

Purpose To compare the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections with respect to successful intra-articular needle placement, fluoroscopy time, radiation dose, and dose area product (DAP). Materials and methods This retrospective study was IRB-approved and HIPAA-compliant. 498 fluoroscopically guided tibiotalar joint injections were performed or supervised by one of nine staff radiologists from 11/1/2010–12/31/2013. The injection approach was determined by operator preference. Images were reviewed on a PACS workstation to determine the injection approach (lateral mortise versus anterior midline) and to confirm intra-articular needle placement. Fluoroscopy time (minutes), radiation dose (mGy), and DAP (μGy-m 2 ) were recorded and compared using the student’s t -test (fluoroscopy time) or the Wilcoxon rank sum test (radiation dose and DAP). Results There were 246 lateral mortise injections and 252 anterior midline injections. Two lateral mortise injections were excluded from further analysis because no contrast was administered. Intra-articular location of the needle tip was documented in 242/244 lateral mortise injections and 252/252 anterior midline injections. Mean fluoroscopy time was shorter for the lateral mortise group than the anterior midline group (0.7 ± 0.5 min versus 1.2 ± 0.8 min, P