Fluoro time

[deleted875186]

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Is there a maximum fluoro time people use that they consider stopping their procedure.

For example, SCS trial with difficulty getting leads in place, rad tech tells you your up to a certain amount of fluoro time.

 

[Ferrismonk]

It takes LOT of flouro to equal a single CT scan or many vascular procedures.

Short answer, flouro time isn't a reason to stop a procedure.

 

[paindoc007]

Stop if you’re done torturing the patient and the lead isn’t threading after numerous attempts. Don’t let it be bc if fluoro time. Remember to always collimate when going live to reduce exposure as well.

 

[lobelsteve]

If you hit 10 min you are having issues and should bail.

 

[Ducttape]

I stop at 4 min 30 sec but the main concern is patient comfort. Previously, my old fluoro machine would automatically overheat/shut down at 4 min 30 sec

granted, I am a wimp when it comes to radiating someone.

At a neighboring interventional pain clinic, fluoro times of 2 min 30 seconds for SI injections are commonplace...

 

[Espn123]

If you hit 10 min you are having issues and should bail.

Just curious how many times you or others have aborted an scs trial? I certainly have but wondering the frequency of experienced guys - seems like the classic “rookie” mistake is to NOT bail when it’s actually called for.

 

[SommeRiver]

I've aborted a trial and an implant.

I've hit 10 min fluoro on a few stim cases, maybe 5 I guess.

Certainly happens, but I haven't had one of those in a very long time.

 

[soccrwz]

low dose, collimate, and pulse can reduce exposure; pulse is a nice trick that can reduce exposure pretty significantly

 

[painfree23]

do you have any barrier shields you like to limit fluoro exposure? ive found them cumbersome and in my way to be honest.

 

[BobBarker]

Maybe the longest was around 11 minutes or so. It was several years ago. Usually I abort a trial after around 30 minutes hands on time. Happens once/year typically.

 

[painfree23]

Maybe the longest was around 11 minutes or so. It was several years ago. Usually I abort a trial after around 30 minutes hands on time. Happens once/year typically.

30 minutes?? thats it? with testing/everything?

 

[lobelsteve]

1 trial, 2 implants. If it aint going, it aint going. Or the cord is going to be at risk.

 

[paindoctor2014]

30 minutes?? thats it? with testing/everything?

I’d guess he doesn’t get to testing if he aborts.

 

[BobBarker]

30 minutes with no usable leads. It means I have accessed the epidural space about 12 times at 4 different locations.

 

[gdub25]

I have the same cutoff as Bob. If I put my gloves on and in half an hour I’d don’t have two leads in good usable position I’ve found that messing around any longer is not going to result in a better outcome. At that point I too would have accessed one side, the other side, another level, etc.

 

[NOSfan]

Adapted from Yale University Radiation Review

 

[NJPAIN]

I always tell patients, especially before a procedure in someone with known difficult anatomy -" I'm not here to torture either one of us. If at any point you don't wish to carry on, let me know and I will stop. I may do the same if I feel like we are getting nowhere". No shame in aborting, regrouping and returning another day if needed, No one likes too much x-ray exposure but that's not a good measure of when to abort. I had a 3 level unilateral RF lumbar MB RFN yesterday with over two minutes of fluoro time. L4 MB and L5 DR target areas so locked in with facet hypertrophy that the landmarks were unrecognizable especially with the L2 and L3 cannulae in place. That was after doing an L4-5 facet joint MB RFN on someone with a Coflex and multilevel kyphoplasty. I should have stayed in bed.