PM&R
Volume 1, Issue 1 , Pages 55-59, January 2009

Interpretation of Contrast Dispersal Patterns by Experienced and Inexperienced Interventionalists

  • Matthew Smuck, MD

      Affiliations

    • The Spine Program, Department of Physical Medicine and Rehabilitation, University of Michigan Health System, 325 E. Eisenhower Parkway, Suite 100, Ann Arbor, MI 48108⁎
    • Corresponding Author InformationAddress correspondence to: M.S.
    • ,
  • Zachary Abbott, DO

      Affiliations

    • The Spine Program, Department of Physical Medicine and Rehabilitation, University of Michigan Health System⁎
    • ,
  • Eric Zemper, PhD

      Affiliations

    • The Spine Program, Department of Physical Medicine and Rehabilitation, University of Michigan Health System⁎

Received 4 March 2008; accepted 4 June 2008. published online 17 November 2008.

Objective

Determine how accurately inexperienced interventionalists interpret epidural contrast dispersal patterns compared with experienced interventionalists.

Design

Prospective comparative study.

Setting

University spine center.

Participants

Two experienced interventionalists and 3 pain fellows in training.

Methods

Each participant independently interpreted 100 images showing contrast dispersal patterns from transforaminal epidural injections. All images were obtained by another physician after 0.5 mL of contrast material was injected. The true contrast dispersal pattern was determined under live fluoroscopy during the injection and classified as follows: epidural only, vascular only, or simultaneous epidural and vascular. Participants were told to assume that 0.5 mL of contrast had been injected before each image and were asked to describe the contrast patterns as epidural, vascular, both, or neither.

Main Outcome Measure

Variance in agreement with the true contrast patterns between experienced and inexperienced participants.

Results

Overall, the inexperienced participants were in exact agreement with the true pattern in 52% of the images versus 70% for experienced participants (P=.03). Experienced participants correctly identified epidural contrast patterns with greater accuracy than inexperienced participants (94% and 76%, respectively; P=.01). Not surprisingly, the accuracy for all participants was low in the identification of vascular patterns on these static images, with 73% accuracy for the experienced and 68% for the inexperienced (P=.18).

Conclusion

Even with 6 months of intensive experience, trainees are significantly less accurate than experienced physicians in the interpretation of contrast dispersal patterns from transforaminal epidural injections. The competency of interventional trainees and the amount of experience necessary to safely perform epidural injections deserve further examination.

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  • ⁎ Disclosure: nothing to disclose
  • ⁎ Disclosure: nothing to disclose
  • ⁎ Disclosure: nothing to disclose

 Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org

PII: S1934-1482(08)00003-8

doi:10.1016/j.pmrj.2008.06.001

PM&R
Volume 1, Issue 1 , Pages 55-59, January 2009

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