Radiation reduction in low dose pulsed fluoroscopy versus standard dose continuous fluoroscopy during fluoroscopically-guided lumbar punctures: A prospective controlled study

Purpose: The purpose of this study was to evaluate radiation dose reduction in fluoroscopically guided lumbar punctures (FGLP) using 'pulsed fluoroscopy in a low dose mode' compared with the commonly used 'continuous fluoroscopy in a standard dose mode' while maintaining the technical success. Materials and Methods: Thirty-five consecutive patients who underwent FGLP divided randomly to seventeen patients in the control group with standard dose continuous FGLP and eighteen patients in the study group with low-dose low-frame-rate of 3 frames per second (fps) FGLP. Entrance surface dose measurements from a dosimeter device were recorded as well as the dose area product (DAP). Results: A total of 35 patients with average age of 52 years (range: 15-87 [±17 standard deviation [SD]) were evaluated. Average entrance surface dose of the study group was significantly lower (3.81 mGy [range: 0.21-11.14, [±2.8 SD]) compared with the control group (22.45 mGy [range: 1.23-73.44, [±19.41 [SD]). The average DAP of the study group (10 mGy·cm² [range: 1-41, [±9.8 SD]) was also significantly lower than the control group (65 mGy·cm² [range: 5-199, [±53 SD]). Success rate was similar between the study and control groups. Conclusion: Low dose pulsed fluoroscopy of 3 fps significantly reduces radiation exposure by about 600% compared with standard dose continuous fluoroscopy in FGLP. Utilizing this radiation saving strategy will allow to dramatically reduce radiation exposure, without impacting the technical success rate.