Fluoroscopy or CT-scan?
The advantage of fluoroscopy over CT-scan is not obvious to the layman. Yet it is the imagery of choice for the treatment of pain in the vast majority of centers.
Benefits
Fluoroscopy:

 

  • Real-time examination (i.e. if you move the needle, the image moves at the same time on the screen)

  • Viewing the entire needle

  • Visualization of an entire volume

  • High spatial resolution (1536x1536 sensor for 30 cm x 30 cm)

  • Low dose of irradiation

  • Easy to clean and integrate into a "sterile" operating room type environment

  • Dedicated use most often

  • Procedure performed by a pain treatment specialist (SSIPM)

  • Reasonable cost of the device

CT-scan:

 

  • Easier to recognize certain anatomical structures (especially in the section plane)

  • Better visualization of non-bony structure (such as disc or root)

  • Possibility of reconstruction in multiple planes (at the cost of an acquisition with many cuts)

  • Dose of radiation received by the doctor and the team reduced (advantage of not being in real time)

  • Profitability of equipment that is often underused (due to the superiority of MRI over CT-scan for many indications)

Disadvantages
Fluoroscopy:

 

  • Difficulty recognizing certain structures if the fluoroscopy angles are incorrectly chosen

  • Invisible non-bony structures (disc, nerve, etc.) and their position is determined in relation to bone landmarks (requires a better knowledge of local anatomy)

  • Dose of radiation received by the doctor higher because the fluoroscopy is done in real time

  • No reconstruction in other plans on conventional devices

  • You have to understand geometry to use images properly

Radioscopie: Effet de zoom
CT-scan:

 

  • Deferred time examination (that is to say, we move the needle blindly, then we make cuts to locate it)

  • Partial visualization of the needle always leaving some uncertainty about the position of its tip

  • Viewing one cut at a time

  • The needle is never completely in the cutting plane

  • Metallic needle artifact interfering with visualization

  • Low spatial resolution (sensor of 1024 for 30 cm) with a slice thickness of about 3 mm ( thinner slices up to 0.6 mm are possible but increase noise ). Subjectively excellent image quality is achieved by mathematical smoothing, not true resolution.

  • High dose of irradiation

  • Difficult to clean and integrate in a "sterile" operating room type environment

  • Shared use (with the risk of bringing resistant germs with patients with multiple diseases)

  • Procedure performed by a radiologist (rarely a specialist in SSIPM pain treatment)

  • You have to understand mathematics and computer science to use images properly

  • High cost of the device

Radioscopie: Parallaxe
Radioscopie: Projection 2D