Dismiss Notice
Hey Texans—join us for a DFW meetup! Click here to learn more.

CT fluoroscopy in pain management

Discussion in 'Pain Medicine' started by nvrsumr, Dec 17, 2008.

  1. nvrsumr

    nvrsumr Member
    10+ Year Member

    Joined:
    Apr 25, 2002
    Messages:
    1,733
    Likes Received:
    369
    Status:
    Attending Physician
    Met an IR guy who is in solo private practice locally and owns his own CT. Said he did fluoro guided pain procedures for years and now has done about 1000 CT fluoroscopy guided pain procedures. When he does CTFESI with CT he can see the vertebral artery and does "live" contrast injection to observe for radicular artery injection. Supposedly, only cost him 30k to upgrade his CT machine to do fluoro and the rad exposure is pretty low because you cone down so much.

    Any thoughts? I did a couple high thoracic sympathetic blocks as a resident with regular CT guidance and thought is was cool but very time intensive. CT fluorscopy: Wave of the future? Can they do biplanar with this?

    Did find this: Cerebellar and brainstem infarction as a complication
    of CT-guided transforaminal cervical nerve root block
    S. Suresh, Skeletal Radiol (2007) 36:449–452
     
  2. Note: SDN Members do not see this ad.

  3. Tenesma

    Tenesma Senior Member
    10+ Year Member

    Joined:
    Jun 11, 2002
    Messages:
    5,332
    Likes Received:
    127
    Status:
    Attending Physician
    1) CT guided anything consummes a lot of time
    2) there is a lot more radiation no matter how much you try to avoid it

    there is a guy in California who does MRI guided injections... i think he works in Santa Monica... now that is really cool.
     
  4. algosdoc

    algosdoc algosdoc
    10+ Year Member

    Joined:
    May 3, 2005
    Messages:
    3,786
    Likes Received:
    1,470
    Status:
    Attending Physician
    My perception is that use of US, CT, or MRI as a means to guide needles is fine, but once the needle tip is in place, these techniques are useless to assist with the degree and location of vascular uptake in real time. CT, as we have seen recently in the literature, causes a risk of cancer increase of up to 0.5% for each CT scan, therefore it is not worth that risk for me to expose my patients to a high radiation endeavor when much lower radiation procedures are available and provide real time feedback. CT is in and out of the scanner or the physician moving in and out of the field many times to place needles. It is kewl, but is time intense. MR requires special expensive needle (non-magnetic).
    Eventually coaxial ultrasound techniques may be the most useful advance in pain medicine imaging, but I am holding out for terra wave technology.
     
  5. Diamox

    10+ Year Member

    Joined:
    Feb 10, 2005
    Messages:
    71
    Likes Received:
    0
    Status:
    Attending Physician
    Terra wave?
     
  6. algosdoc

    algosdoc algosdoc
    10+ Year Member

    Joined:
    May 3, 2005
    Messages:
    3,786
    Likes Received:
    1,470
    Status:
    Attending Physician
    They are forms of non-ionizing radiation...
     

Share This Page