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The Evolution of Image Guidance & Injection Therapy


Injection therapy is commonly used by pain physicians for the diagnosis and treatment of various conditions. Injections can be used as a diagnostic tool to aid in identifying the exact pain generator, or cause of pain. By injecting a local anesthetic into a specific area, joint or nerve, the pain specialist can evaluate if this specific location is the cause of the patient’s particular pain. In order to expect the highest success rate with treatment, the injection must be administered to the correct location. Injection therapy is continuously evolving to provide the utmost accuracy in identifying the structure in question and injecting the medication. Initially, anesthesiologists relied on simply feeling the anatomic landmarks to place their injections. Experienced physicians become more adept at performing injections without visible confirmation.

Then came the advent of fluoroscopy (live x-rays) to assist with injections. Pain specialists use this real time x-ray imagery to confirm needle tip placement during an injection. Fluoroscopy allows for better visualization of bony structures and joints to improve the accuracy of injections. The drawbacks with fluoroscopy involve exposure to radiation (albeit, in very small doses) and an inability to see soft tissue structures, like muscle and tendon, as well as vascular structures, like arteries and veins.

More recently, a different kind of image guidance for injections is being used. Ultrasound technology has been around for a long time but previously has been used mainly for diagnostic testing in other fields of medicine like obstetrics. Ultrasound uses sound waves that travel though tissues and structures of different densities to create a picture. It let’s the provider see soft tissue structures that were previously not easily visualized with fluoroscopy.  Ultrasound allows for diagnostic evaluation of painful areas to assess for scar tissue, thickening, and swelling as well as seeing areas to avoid injecting like arteries and veins. Ultrasound is quick, easy, painless and portable. There is no contraindication to its use and no concern with radiation exposure. Ultrasound guidance, at this point, may be the most accurate and safest way to guide pain injections. Of course, this depends on the doctor’s experience with this new technique. We often use ultrasound-guided assistance when appropriate for our injection therapy.

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