Efficiency of lead aprons in blocking radiation − how protective are they?

Abstract

BackgroundDespite the firmly established occupational risk of exposure to X-rays, they are used extensively in spine surgeries. Shielding by lead aprons is the most common protective practice. We quantified the level of their radiation blocking ability in a real-life setting.MethodsSingle-center, prospective, randomized study of adult patients with degenerative lumbar disorders, scheduled to undergo posterior lumbar interbody fusion. Instrumentation was performed in either a robot-assisted, minimally invasive approach (RO) or a conventional, fluoroscopically-assisted, open approach (FA). Outcome measures included the quantitative measurement of the surgeon’s actual exposure to radiation, as recorded by thermo-luminescent dosimeters (TLD) worn both above and under the 0.5 mm thyroid and trunk lead protectors.FindingsSixty four patients were included in this study, 34 in the RO cohort and 30 in the FA cohort. The radiation blocked by the aprons, represented as the ratio of the under-apron to above-apron TLDs, averaged 37.1% (range 25.4–48.3%, 95% confidence interval between 30.6–43.6%). In the RO cohort, the average per-screw radiation dose and time were 51.9% and 73.7% lower, respectively, than the per screw exposure in the FA cohort.InterpretationThe 0.5 mm lead aprons blocked just over one third of the radiation scattered towards the surgeon. Use of robotic-guidance in a minimally invasive approach provided for a reduction of 62.5% of the overall radiation the surgeon was exposed to during open conventional approach. We conclude that reduced radiation use (e.g. by using robotic guidance) is a more effective strategy for minimizing exposure to radiation than reliance on protection by lead aprons, and recommend utilization of practices and technologies that reduce the surgical team’s routine exposure to X-rays.

First experience with zero-fluoroscopic ablation for supraventricular tachycardias using a novel impedance and magnetic-field-based mapping system

“…Furthermore, wearing lead protection has been associated with fatigue and orthopadic complaints for laboratory staff [16], although lead aprons block just about one-third of scattered radiation [17]. Given these well-recognized hazards, it is vitally important that zero- or near-zero-fluoroscopic approaches in EP are explored and refined, to minimise risks.…”

“…It is not just patients who are at risk, but operators too; a growing body of evidence exists implicating radiation exposure in vascular disease [ 13 ], cognitive impairment [ 14 ], and tumours of the brain and neck [ 15 ] in physicians who perform fluoroscopic-guided interventional procedures. Furthermore, wearing lead protection has been associated with fatigue and orthopadic complaints for laboratory staff [ 16 ], although lead aprons block just about one-third of scattered radiation [ 17 ]. Given these well-recognized hazards, it is vitally important that zero- or near-zero-fluoroscopic approaches in EP are explored and refined, to minimise risks.…”

Freehand S2 Alar-Iliac Screw Placement Using K-Wire and Cannulated Screw : Technical Case Series

“…However, screw placement under fluoroscopic guidance requires more surgical time and carries a risk of radiation exposure for both surgeons and patients, despite the use of protective equipment and devices. Moreover, a recent study demonstrated that lead aprons were less protective than expected 5) . As previously reported in the cadaveric study 15) , free hand insertion technique of S2AI screw could be an alternative method to address these concerns.…”

Comparative Retrospective Analysis of Accuracy of Robotic-Guided versus Fluoroscopy-Guided Percutaneous Pedicle Screw Placement in Adults with Degenerative Spine Disease

“…Navigation systems have been shown to increase pedicle screw placement accuracy compared to freehand techniques, from about 90-91% to around 95-97% [4,5]. Robotic guidance systems have shown similar or higher levels of accuracy [6,7,20], even when used in MIS procedures and compared to a freehand open approach [8,9,21,23]. In addition, Kim et al showed a decrease in radiation doses to below detectable levels when integrating navigated-assisted fluoroscopy in MIS-TLIF, in contrast to a mean 12.4 mREM radiation dose in open, standard fluoroscopy TLIFs [11].…”