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Radiation dose and intra-articular access: comparison of the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections
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...
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| Published in: | Skeletal radiology 2016-03, Vol.45 (3), p.367-373 |
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| creator | Huang, Ambrose J. Balza, Rene Torriani, Martin Bredella, Miriam A. Chang, Connie Y. Simeone, Frank J. Palmer, William E. |
| description | 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
|
| doi_str_mv | 10.1007/s00256-015-2300-8 |
| format | article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_1760901833</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A731035112</galeid><sourcerecordid>A731035112</sourcerecordid><originalsourceid>FETCH-LOGICAL-c481t-bc62ee1004d6ee58e382a564653f775e2df75cc552b72d36359186a6079c82c73</originalsourceid><addsrcrecordid>eNp1kc2KFDEUhYMoTs_oA7iRgBs3Nean8tPuhkEdYUAQXRfp5FZPmlRSJlWLeR5f1Nt0KyJIFoF7v3Nzcg8hrzi75oyZd40xoXTHuOqEZKyzT8iG91J0gmv-lGyY1D12entBLls7MMaNUfo5uRBac2mk2JCfX12Ibokl01AaUJcDjXmprnN1iX5NrlLnPbT2nvoyza7GhmwZ6fIANLkFqkt0Kgif1S5jLZZKpxhSzFic51qcf4BGl0LHtJZami9z9C6lR7pfY4BAl7iLZXHH9w4FHaCLA_ijsfaCPBtdavDyfF-R7x8_fLu96-6_fPp8e3Pf-d7ypdt5LQBwMX3QAMqCtMIp3WslR_w3iDAa5b1SYmdEkFqqLbfaaWa23gpv5BV5e5qLfn-s0JZhis1DSi5DWdvAjWZbxq2UiL75Bz2UtWZ0h5Qy1shebpG6PlF7l2CIeSy4WI8nwBR9yTBGrN8YyZlUnAsU8JPA44pahXGYa5xcfRw4G46RD6fIB4x8OEY-WNS8PltZdxOEP4rfGSMgTkDDVt5D_cvrf6f-Au_RuO0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1757873439</pqid></control><display><type>article</type><title>Radiation dose and intra-articular access: comparison of the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections</title><source>Springer Nature</source><creator>Huang, Ambrose J. ; Balza, Rene ; Torriani, Martin ; Bredella, Miriam A. ; Chang, Connie Y. ; Simeone, Frank J. ; Palmer, William E.</creator><creatorcontrib>Huang, Ambrose J. ; Balza, Rene ; Torriani, Martin ; Bredella, Miriam A. ; Chang, Connie Y. ; Simeone, Frank J. ; Palmer, William E.</creatorcontrib><description>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
< 0.0001). Mean radiation dose and DAP were less for the lateral mortise group than the anterior midline group (2.1 ± 3.7 mGy versus 2.5 ± 3.5 mGy,
P
= 0.04; 11.5 ± 15.3 μGy-m
2
versus 13.5 ± 17.3 μGy-m
2
,
P
= 0.006).
Conclusion
Both injection approaches resulted in nearly 100 % rates of intra-articular needle placement, but the lateral mortise approach used approximately 40 % less fluoroscopy time and delivered 15 % lower radiation dose and DAP to the patient.</description><identifier>ISSN: 0364-2348</identifier><identifier>EISSN: 1432-2161</identifier><identifier>DOI: 10.1007/s00256-015-2300-8</identifier><identifier>PMID: 26613732</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>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</subject><ispartof>Skeletal radiology, 2016-03, Vol.45 (3), p.367-373</ispartof><rights>ISS 2015</rights><rights>COPYRIGHT 2016 Springer</rights><rights>ISS 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c481t-bc62ee1004d6ee58e382a564653f775e2df75cc552b72d36359186a6079c82c73</citedby><cites>FETCH-LOGICAL-c481t-bc62ee1004d6ee58e382a564653f775e2df75cc552b72d36359186a6079c82c73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26613732$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huang, Ambrose J.</creatorcontrib><creatorcontrib>Balza, Rene</creatorcontrib><creatorcontrib>Torriani, Martin</creatorcontrib><creatorcontrib>Bredella, Miriam A.</creatorcontrib><creatorcontrib>Chang, Connie Y.</creatorcontrib><creatorcontrib>Simeone, Frank J.</creatorcontrib><creatorcontrib>Palmer, William E.</creatorcontrib><title>Radiation dose and intra-articular access: comparison of the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections</title><title>Skeletal radiology</title><addtitle>Skeletal Radiol</addtitle><addtitle>Skeletal Radiol</addtitle><description>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
< 0.0001). Mean radiation dose and DAP were less for the lateral mortise group than the anterior midline group (2.1 ± 3.7 mGy versus 2.5 ± 3.5 mGy,
P
= 0.04; 11.5 ± 15.3 μGy-m
2
versus 13.5 ± 17.3 μGy-m
2
,
P
= 0.006).
Conclusion
Both injection approaches resulted in nearly 100 % rates of intra-articular needle placement, but the lateral mortise approach used approximately 40 % less fluoroscopy time and delivered 15 % lower radiation dose and DAP to the patient.</description><subject>Anesthetics - administration & dosage</subject><subject>Arthralgia - diagnostic imaging</subject><subject>Arthralgia - drug therapy</subject><subject>Arthrography - methods</subject><subject>Comparative analysis</subject><subject>Female</subject><subject>Fluoroscopy - methods</subject><subject>Humans</subject><subject>Imaging</subject><subject>Injections, Intra-Articular - methods</subject><subject>Injections, Intralesional - methods</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Nuclear Medicine</subject><subject>Orthopedics</subject><subject>Pathology</subject><subject>Privacy, Right of</subject><subject>Radiation</subject><subject>Radiation Dosage</subject><subject>Radiation Exposure - analysis</subject><subject>Radiation Exposure - prevention & control</subject><subject>Radiation Protection - methods</subject><subject>Radiography, Interventional - methods</subject><subject>Radiology</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Scientific Article</subject><subject>Sensitivity and Specificity</subject><subject>Tarsal Joints - diagnostic imaging</subject><issn>0364-2348</issn><issn>1432-2161</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNp1kc2KFDEUhYMoTs_oA7iRgBs3Nean8tPuhkEdYUAQXRfp5FZPmlRSJlWLeR5f1Nt0KyJIFoF7v3Nzcg8hrzi75oyZd40xoXTHuOqEZKyzT8iG91J0gmv-lGyY1D12entBLls7MMaNUfo5uRBac2mk2JCfX12Ibokl01AaUJcDjXmprnN1iX5NrlLnPbT2nvoyza7GhmwZ6fIANLkFqkt0Kgif1S5jLZZKpxhSzFic51qcf4BGl0LHtJZami9z9C6lR7pfY4BAl7iLZXHH9w4FHaCLA_ijsfaCPBtdavDyfF-R7x8_fLu96-6_fPp8e3Pf-d7ypdt5LQBwMX3QAMqCtMIp3WslR_w3iDAa5b1SYmdEkFqqLbfaaWa23gpv5BV5e5qLfn-s0JZhis1DSi5DWdvAjWZbxq2UiL75Bz2UtWZ0h5Qy1shebpG6PlF7l2CIeSy4WI8nwBR9yTBGrN8YyZlUnAsU8JPA44pahXGYa5xcfRw4G46RD6fIB4x8OEY-WNS8PltZdxOEP4rfGSMgTkDDVt5D_cvrf6f-Au_RuO0</recordid><startdate>20160301</startdate><enddate>20160301</enddate><creator>Huang, Ambrose J.</creator><creator>Balza, Rene</creator><creator>Torriani, Martin</creator><creator>Bredella, Miriam A.</creator><creator>Chang, Connie Y.</creator><creator>Simeone, Frank J.</creator><creator>Palmer, William E.</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20160301</creationdate><title>Radiation dose and intra-articular access: comparison of the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections</title><author>Huang, Ambrose J. ; Balza, Rene ; Torriani, Martin ; Bredella, Miriam A. ; Chang, Connie Y. ; Simeone, Frank J. ; Palmer, William E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c481t-bc62ee1004d6ee58e382a564653f775e2df75cc552b72d36359186a6079c82c73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Anesthetics - administration & dosage</topic><topic>Arthralgia - diagnostic imaging</topic><topic>Arthralgia - drug therapy</topic><topic>Arthrography - methods</topic><topic>Comparative analysis</topic><topic>Female</topic><topic>Fluoroscopy - methods</topic><topic>Humans</topic><topic>Imaging</topic><topic>Injections, Intra-Articular - methods</topic><topic>Injections, Intralesional - methods</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Nuclear Medicine</topic><topic>Orthopedics</topic><topic>Pathology</topic><topic>Privacy, Right of</topic><topic>Radiation</topic><topic>Radiation Dosage</topic><topic>Radiation Exposure - analysis</topic><topic>Radiation Exposure - prevention & control</topic><topic>Radiation Protection - methods</topic><topic>Radiography, Interventional - methods</topic><topic>Radiology</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Scientific Article</topic><topic>Sensitivity and Specificity</topic><topic>Tarsal Joints - diagnostic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huang, Ambrose J.</creatorcontrib><creatorcontrib>Balza, Rene</creatorcontrib><creatorcontrib>Torriani, Martin</creatorcontrib><creatorcontrib>Bredella, Miriam A.</creatorcontrib><creatorcontrib>Chang, Connie Y.</creatorcontrib><creatorcontrib>Simeone, Frank J.</creatorcontrib><creatorcontrib>Palmer, William E.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Skeletal radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huang, Ambrose J.</au><au>Balza, Rene</au><au>Torriani, Martin</au><au>Bredella, Miriam A.</au><au>Chang, Connie Y.</au><au>Simeone, Frank J.</au><au>Palmer, William E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Radiation dose and intra-articular access: comparison of the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections</atitle><jtitle>Skeletal radiology</jtitle><stitle>Skeletal Radiol</stitle><addtitle>Skeletal Radiol</addtitle><date>2016-03-01</date><risdate>2016</risdate><volume>45</volume><issue>3</issue><spage>367</spage><epage>373</epage><pages>367-373</pages><issn>0364-2348</issn><eissn>1432-2161</eissn><abstract>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
< 0.0001). Mean radiation dose and DAP were less for the lateral mortise group than the anterior midline group (2.1 ± 3.7 mGy versus 2.5 ± 3.5 mGy,
P
= 0.04; 11.5 ± 15.3 μGy-m
2
versus 13.5 ± 17.3 μGy-m
2
,
P
= 0.006).
Conclusion
Both injection approaches resulted in nearly 100 % rates of intra-articular needle placement, but the lateral mortise approach used approximately 40 % less fluoroscopy time and delivered 15 % lower radiation dose and DAP to the patient.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>26613732</pmid><doi>10.1007/s00256-015-2300-8</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0364-2348 |
| ispartof | Skeletal radiology, 2016-03, Vol.45 (3), p.367-373 |
| issn | 0364-2348 1432-2161 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1760901833 |
| source | Springer Nature |
| 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 |
| title | Radiation dose and intra-articular access: comparison of the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections |
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