Image Guided Injection Procedures in Miami
At our Miami clinic, every injection procedure performed by Dr. William Bonner is carried out under real-time image guidance — either ultrasound or fluoroscopy (X-ray). This is not simply a preference; it is a fundamental standard of care that directly affects the accuracy, safety, and effectiveness of each procedure.
Image guidance means Dr. Bonner can see exactly where the needle is going in real time — confirming precise placement before any medication is delivered, and significantly reducing the risk of complications from blind or landmark-based injections.
Why Image Guidance Matters
Research has consistently demonstrated that injections performed without image guidance have a significant miss rate — meaning the needle and medication may not reach the intended target. This applies across a wide range of procedures, including epidural injections, facet joint injections, and intraarticular joint injections.
When an injection misses its target:
- Therapeutic medication is not delivered to the correct tissue
- The patient may experience little or no benefit from the procedure
- A false-negative diagnostic result may lead the physician away from the correct diagnosis
- The risk of inadvertent needle contact with nerves, vessels, or other structures increases
Image-guided procedures eliminate these issues by allowing real-time visualization of needle position throughout the entire injection process.
Types of Image Guidance Used at Our Clinic
Ultrasound Guidance
Ultrasound uses high-frequency sound waves to create real-time images of soft tissue structures — including tendons, ligaments, bursae, joint capsules, and nerves. It is particularly valuable for:
- Peripheral joint injections (knee, hip, shoulder, ankle, elbow)
- Tendon and soft tissue injections
- Bursa injections
- Nerve hydrodissection procedures
- Superficial musculoskeletal structures
Advantages of ultrasound include no radiation exposure, real-time imaging of soft tissue, and the ability to visualize needle movement and medication spread dynamically during the injection.
Fluoroscopic (X-Ray) Guidance
Fluoroscopy uses continuous X-ray imaging to visualize bony structures and the position of the needle relative to the spine or joint in real time. It is the standard of care for:
- Epidural steroid injections (transforaminal, interlaminar, caudal)
- Facet joint injections
- Medial branch blocks
- Radiofrequency ablation (RFA)
- Sacroiliac joint injections
- Intraosseous procedures
Fluoroscopy allows contrast dye confirmation of needle position — a critical safety step that ensures medication is delivered to the correct anatomical space and not inadvertently into a blood vessel.
Image-Guided Procedures Offered at Our Miami Clinic
| Procedure | Guidance Type | Primary Use |
| Epidural Steroid Injection | Fluoroscopy | Nerve root inflammation, sciatica, disc herniation |
| Facet Joint Injection | Fluoroscopy | Facet arthritis, axial neck/back pain |
| Medial Branch Block | Fluoroscopy | Facet pain diagnosis, pre-RFA evaluation |
| Radiofrequency Ablation (RFA) | Fluoroscopy | Long-lasting facet pain relief |
| SI Joint Injection | Fluoroscopy | Sacroiliac joint pain |
| PRP Therapy | Ultrasound / Fluoroscopy | Tendon, ligament, joint, and disc healing |
| BMAC Stem Cell Therapy | Ultrasound / Fluoroscopy | Advanced joint degeneration, tissue repair |
| Knee / Hip / Shoulder Injections | Ultrasound | Intraarticular injections for OA and soft tissue |
| Tendon / Bursa Injections | Ultrasound | Tendinopathy, bursitis, soft tissue injuries |
Frequently Asked Questions
Are all injection procedures at your clinic done under image guidance?
Yes. Dr. Bonner performs all injection procedures under ultrasound or fluoroscopic guidance. No injections are performed blindly or by landmark technique alone at our clinic.
Does image guidance make the procedure safer?
Yes. Image guidance significantly reduces the risk of inadvertent needle contact with nerves, blood vessels, or other unintended structures. Contrast confirmation during fluoroscopic procedures ensures medication is not injected intravascularly.
Does image guidance mean the procedure takes longer?
Image-guided procedures take slightly longer to set up, but the actual injection takes only a few minutes once the needle is accurately positioned. Most procedures are completed within 15–45 minutes from start to finish.
Is fluoroscopy safe? How much radiation is involved?
Fluoroscopy exposes patients to a small amount of radiation — far less than a diagnostic CT scan. Dr. Bonner uses careful technique to minimize radiation exposure while maintaining complete diagnostic accuracy.
Does the use of ultrasound or fluoroscopy cost more?
Image guidance is included as a standard part of every procedure at our clinic. It is not an optional add-on — it is how Dr. Bonner performs every injection as a matter of clinical standard.
Schedule a Consultation
If you are experiencing pain and want to determine whether an image-guided injection is appropriate for you, we are here to help.
Contact our Miami clinic to schedule an appointment with Dr. Bonner, or book online through ZocDoc for available appointment times (if you do not see availability, please reach out to us directly at 786-522-4959).