Fluoroscopically guided steroid injections

Over 283,000 gastrostomy-related services were performed in 2003, 10% of these were performed by radiology service [ 2 ]. The important benefits of enteral nutrition have been well established. In their review of the published literature, Gramlich et al. have confirmed that patients have less infectious complications when on enteral feedings [ 3 ]. PFG-tube placement has several advantages. Firstly, gastric access for insufflation can be readily obtained with a small feeding tube which the patient can swallow or can be guided into the stomach using fluoroscopy. Where gastric access is difficult because of tumor or other defects, a five French (F) angled catheter and guide wire can be readily passed under fluoroscopy. Secondly, as we have illustrated, fluoroscopy is much better at outlining the distended stomach when transillumination is not possible with the endoscope. Since BMI above 30 is a known risk factor for complications and mortality post tube placement [ 4 ], multiplanar imaging must be used to exclude viscera from the intended access path. A steep RAO view of the abdomen or true lateral view is helpful in identifying viscera intestinal components anterior to the stomach. Additionally, very dilute barium given the day before the exam serves to highlight the colon and prevent inadvertent transcolonic peg tube access. Lastly, if attempts to pass the guide wire up the esophagus fail, then the gastric tube can be snared and used to advance the snare to the oropharynx for capture. Lastly, if access to the esophagus proves to be elusive, then two or three T-fasteners might be placed to secure the stomach to the anterior abdominal wall and the balloon-tipped G-tube passed into the stomach with a track developed by a 24 French dilator and peel-away sheath. The gastric balloon is inflated and the peel-away sheath removed.

Dr. Gerber specializes in the diagnosis and treatment of spine disorders, work and sports related injuries and the management of acute and chronic pain.  He offers patients an individualized and aggressive, nonsurgical treatment approach, which may consist of physical or occupational therapy, aquatic and therapeutic exercises, medications, local injections and/or fluoroscopically guided spinal injections. If surgery is necessary, he works closely with the areas best surgeons and will be able to coordinate both pre and post-operative pain management. Most importantly, Dr. Gerber is concerned with improving function and the quality of his patients lives.


The increase in medical radiation exposure was highlighted by the National Council on Radiation Protection and Measurements (NCRP) Report 160  (2009). In 2010 the FDA Center for Devices and Radiological Health (CDRH) launched an Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging . As part of this initiative, the FDA held a public meeting on ways to improve devices to reduce unnecessary radiation exposure to help the agency decide on any new targeted requirements for manufacturers of CT and fluoroscopic devices. The new requirements that could be built into fluoroscopy equipment could facilitate implementation of the principles of justification and optimization in the protection of patients undergoing radiological examinations. These principles, implemented through a clinical facility’s quality assurance program, are fundamental to radiation protection.

Important: Please do not send us documents other than those listed below, as this creates unnecessary paperwork. If other documents are deemed necessary (., medical school transcripts, USMLE score transcripts, residency rotation reports) we will contact you and request the specific documents. We do not require the Universal Fellowship Application Form, so there is no need to send one with your application materials.

You may send your application documents piecemeal, as long as you send only the required documents.

Due to the large number of applications we receive every year, we strongly encourage you to follow these three steps regarding application materials:

1. Required documents:
- Curriculum vitae (please see note below regarding format)
- Personal statement (please see note below regarding format)
- Three letters of recommendation (no specific format)
- Waiver for Recommendations

2. Follow these formats:
Curriculum Vitae
Personal statement: State why you are willing to pursue a Musculoskeletal Imaging & Intervention Fellowship position at MGH. Do not exceed one page, use single space, font Arial 11 or Times 12, with one-inch margins. Please include your USMLE scores.

3. Send your application materials to:


Connie Y. Chang, MD
Musculoskeletal Imaging & Intervention, Fellowship Director
c/o Ms. Michelle Cardillo
Division of Musculoskeletal Imaging & Intervention
Massachusetts General Hospital
Department of Radiology
55 Fruit Street, YAW6033
Boston, MA USA 02114

If you wish, you may send your CV and personal statement by email to Ms. Cardillo

Fluoroscopically guided steroid injections

fluoroscopically guided steroid injections

Important: Please do not send us documents other than those listed below, as this creates unnecessary paperwork. If other documents are deemed necessary (., medical school transcripts, USMLE score transcripts, residency rotation reports) we will contact you and request the specific documents. We do not require the Universal Fellowship Application Form, so there is no need to send one with your application materials.

You may send your application documents piecemeal, as long as you send only the required documents.

Due to the large number of applications we receive every year, we strongly encourage you to follow these three steps regarding application materials:

1. Required documents:
- Curriculum vitae (please see note below regarding format)
- Personal statement (please see note below regarding format)
- Three letters of recommendation (no specific format)
- Waiver for Recommendations

2. Follow these formats:
Curriculum Vitae
Personal statement: State why you are willing to pursue a Musculoskeletal Imaging & Intervention Fellowship position at MGH. Do not exceed one page, use single space, font Arial 11 or Times 12, with one-inch margins. Please include your USMLE scores.

3. Send your application materials to:


Connie Y. Chang, MD
Musculoskeletal Imaging & Intervention, Fellowship Director
c/o Ms. Michelle Cardillo
Division of Musculoskeletal Imaging & Intervention
Massachusetts General Hospital
Department of Radiology
55 Fruit Street, YAW6033
Boston, MA USA 02114

If you wish, you may send your CV and personal statement by email to Ms. Cardillo

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