Ambrose J Huang1, Rene Balza2, Martin Torriani3, Miriam A Bredella4, Connie Y Chang5, Frank J Simeone6, William E Palmer7. 1. Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street, Yawkey 6E, Boston, MA, 02114, USA. ajhuang@mgh.harvard.edu. 2. Department of Radiology, Centro Medico de Occidente, Maracaibo, Venezuela. renebalza@gmail.com. 3. Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street, Yawkey 6E, Boston, MA, 02114, USA. mtorriani@mgh.harvard.edu. 4. Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street, Yawkey 6E, Boston, MA, 02114, USA. mbredella@mgh.harvard.edu. 5. Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street, Yawkey 6E, Boston, MA, 02114, USA. cychang@mgh.harvard.edu. 6. Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street, Yawkey 6E, Boston, MA, 02114, USA. fsimeone@mgh.harvard.edu. 7. Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street, Yawkey 6E, Boston, MA, 02114, USA. wpalmer@mgh.harvard.edu.
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.
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.
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Authors: M J Mitchell; D Bielecki; A G Bergman; S Kursunoglu-Brahme; D J Sartoris; D Resnick Journal: AJR Am J Roentgenol Date: 1995-06 Impact factor: 3.959
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