nvrsumr

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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
 

Tenesma

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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.
 

Aether2000

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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.
 
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Diamox

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Feb 10, 2005
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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.
Terra wave?
 
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