Issue #7: March 2013

Fluoroscopy Use for Interventional Spinal Injections and Pain Management Procedures

By: Tammi Vicars, RT

The use of fluoroscopy in the Interventional Spine and Pain Management injection procedures is not only considered a better practice, but it is now a requirement for the majority of procedures, since it is bundled within the procedure code in most cases.

There are multiple reasons as to why fluoroscopy must be utilized for spine injections and pain management procedures:

1. Increase successful outcomes by ensuring direct fluoroscopic visualization to ensure correct needle placement through direct visualization of necessary anatomy of the spine using specific views obtained for each procedure.
2. Contrast dye is injected under direct fluoroscopic visualization to ensure correct flow of medication to be injected, as well as the confirmation that there is no vascular uptake.
3. The injections are not only therapeutic but they can also be diagnostic for which it is imperative to have correct needle placement which can be accomplished with fluoroscopic guidance.
4. Increase patient safety by minimizing complications from incorrect needle placement and injections in the wrong structures.

The Physician performing the procedures must be trained and well versed on the fluoroscopy image in order to recognize the anatomy under fluoroscopic visualization, correct needle placement and recognize vascular uptake or contrast distribution on incorrect location.

The provider must also be confident in being able to provide direction to the Radiology Technologist in necessary movement and positioning of the fluoroscope to obtain the correct image necessary to perform a safe procedure.

There are various options to attend fluoroscopic image training courses; however the most highly recommended way to become knowledgeable in fluroscopy use, interpretation and safety is through an Interventional Spine Injection Fellowship. During the provider time in the fellowship training besides getting direct specialized training on performance of the procedures under fluoroscopy, they will also acquire the very important knowledge of radiation safety which is crucial in minimizing radiation exposure to patient, physician and other staff in the procedure room.

The final goal is to help out patients by maximizing efficacy and minimize complications of the interventions by assuring proper placement with fluoroscopy guidance.

Tammi Vicars has many years of experience as a Radiology Technologist (RT) working in Interventional Pain Management in Fort Collins, Colorado.