Technique: Global Rules

Strict sterility is mandatory. All staff members should wear clean scrub clothes, caps and masks and radiation protection devices. The patient is covered with sterile drapes. A large sterile table should be used for all medical material used during the procedure. (Figure 1 and Figure 2).

Preliminary steps:

The patient is positioned on the CT table and a first acquisition is performed for procedure planning. To avoid unnecessary x-ray exposure to the patient, a low dose protocol is used. Distally to the puncture area, the patient is covered with a lead drape (Figure 3a: *) to minimize scattered radiation to the physician and technologists. The anatomical area to be treated is prepared with a full sterile scrub. A sterile sheet is than placed on the patient, leaving a 10cm opening for percutaneous approach (Figure 3b).

Radiation protection:

Direct x-ray exposure to the operator’s fingers is avoided using a needle holder (Figure 4). Scattered radiation exposure to the physician is minimized, using a lead drape on the patient, latex radiation protection gloves, lead glasses and classical body and thyroid lead protection. Combination of these radiation protection measures results in 97% decrease of radiation exposure to the radiologist and minimal direct x-ray exposure to the patient (Figure 5).

Anesthesia:

In our experience, local anesthesia (lidocaine 2%, 10 mL) without conscious sedation is only used for specific procedures (such as nucleoplasty, vertebroplasty and thoracic neurolysis) allowing significant reduction of patient discomfort (Figure 6).

Image Guidance:

Multislice CT fluoroscopy makes C-arm assistance unnecessary. A flat panel screen showing three contiguous CT slices (Figure 7) allows direct and continuous visualization of needle progression and injections (air, contrast média, cement,…).