Occupational Exposure From Common Fluoroscopic Projections Used in Orthopaedic Surgery

Theocharopoulos, Nicholas; Perisinakis, Kostas; Damilakis, John; Papadokostakis, George; Hadjipavlou, Alexander; Gourtsoyiannis, Nicholas

doi:10.2106/00004623-200309000-00007

Cited by 190 publications

(122 citation statements)

References 17 publications

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“…Numerous reports have documented the harmful effects of radiation exposure to the surgeon and the operative team, 16,23,27,31,37,39 including cases of cancer and sarcoma from cumulative fluoroscopic radiation exposure, 1,28,32,44 and grave concerns exist regarding the stochastic effects of ionizing radiation. 15,27,31 Even with the protection of lead aprons, thyroid shields, and lead glasses, many parts of the surgeon's body remain unprotected during fluoroscopy and can accumulate a significant amount of scatter ionizing radiation exposure.…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiographic outcomes of minimally invasive percutaneous pedicle screw placement with intraoperative CT (O-arm) image guidance navigation

Kim¹,

Drazin

Shweikeh

et al. 2014

FOC

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Object Intraoperative CT image–guided navigation (IGN) has been increasingly incorporated into minimally invasive spine surgery (MIS). The vast improvement in image resolution and virtual real-time images with CT-IGN has proven superiority over traditional fluoroscopic techniques. The authors describe their perioperative MIS technique using the O-arm with navigation, and they report their postoperative experience, accuracy results, and technical aspects. Methods A retrospective review of 48 consecutive adult patients undergoing minimally invasive percutaneous posterior spinal fusion with intraoperative CT-IGN between July 2010 and August 2013 at Cedars-Sinai Medical Center was performed. Two surgeons assessed 290 screws in a blinded fashion on intraoperative O-arm images and postoperative CT scans for bony pedicle wall breach. Grade 1 breach was defined to be < 2 mm, Grade 2 breach to be between 2 and 4 mm, and a Grade 3 breach to be > 4 mm. Additionally, anterior vertebral body breach was recorded. Results Of 290 pedicle screws placed, 280 (96.6%) were in an acceptable position without cortical wall or anterior breach. Of the 10 breaches (3.4%) 5 were lateral (50%), 4 were medial, and 1 was anterior; 90% of breaches were Grade 1–2 and all medial breaches were Grade 1. The one Grade 3 breach was lateral. No vascular or neurological complications were observed intraoperatively, and no significant postoperative complications were noted. The mean clinical follow-up period was 18 months (range 3–39 months). The overall clinical outcomes, measured using the visual analog scale (back pain scores), were improved significantly postoperatively at 3 months compared with preoperatively (visual analog score 6.35 vs 3.57; p < 0.0001). No revision surgery was performed for screw misplacement or neurological deterioration. Conclusions New CT-IGN with the mobile O-arm scanner has increased the accuracy of pedicle screw/instrumentation placement using MIS techniques. The authors' high (96.6%) accuracy rate in MIS compares favorably with historical published accuracy rates for fluoroscopy-based techniques. Additional advantages of CT-IGN over fluoroscopic imaging methods are lower occupational radiation exposure for the surgical team, reduced need for postoperative imaging, and decreased rates of revision surgery. For now, the authors simply conclude that use of intraoperative CT-IGN is safe and accurate.

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Section: Discussionmentioning

confidence: 99%

Clinical and radiographic outcomes of minimally invasive percutaneous pedicle screw placement with intraoperative CT (O-arm) image guidance navigation

Kim¹,

Drazin

Shweikeh

et al. 2014

FOC

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“…6,7 The range of operative procedures requiring image intensifier screening has led to an interest by orthopaedic surgeons in their exposure to ionising radiation. [8][9][10][11] Studies have considered exposure during experimental operation set-ups on phantom patients, 12 during common trauma operations, [13][14][15] for different locations and personnel in the operating theatre, [16][17][18] for different parts of the body, 19 and also investigating methods to reduce exposure. 20,21 There is evidence, however, that actual practice of basic ionising radiation protection varies widely.…”

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confidence: 99%

Ionising Radiation Exposure to Orthopaedic Trainees: The Effect of Sub-Specialty Training

Oddy

Aldam

2006

annals

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INTRODUCTION We monitored image intensifier use by orthopaedic trainees to assess their exposure to ionising radiation and to investigate the influence of sub-specialty training.MATERIALS AND METHODS Five different orthopaedic registrars recorded their monthly image intensifier screening times and exposure doses for all cases (trauma and elective), for a combined total of 12 non-consecutive months. Radiation exposure was monitored using shoulder and waist film badges worn both by surgeons and radiographers screening their cases.RESULTS Registrars in spinal sub-specialties were exposed to significantly higher doses per case and cumulative doses per month than non-spinal trainees (P < 0.05), but significantly lower screening times per case (P < 0.05). There were no significant differences in cumulative screening times per month (P > 0.05). Regression analysis for all surgeons showed a significant relationship between shoulder film badge reading and cumulative dose exposed per month (P < 0.05), but not for cumulative screening time. Shoulder film badge recordings were significantly higher for spinal compared with non-spinal registrars (P < 0.05), although all badges were below the level for radiation reporting. Only one radiographer badge recorded a dose above threshold.CONCLUSIONS Whilst the long-term effects of sub-reporting doses of radiation are not fully understood, we consider that this study demonstrates that trainees should not be complacent in accepting inadequate radiation protection. The higher doses encountered with spinal imaging means that sub-specialty trainees should be alerted to the risk of their increased exposure. The principle of minimising radiation exposure must be maintained by all trainees at all times.

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“…Previous data reveals the effective dose to the orthopaedic surgeon working tableside during a typical fluoroscopic-guided hip procedure was 2.5 mSV when a lead equivalent apron and thyroid shield were used [21]. A previous study used a anthropomorphic phantom model to simulate the radiation dose to operating room personnel during image-guided orthopaedic surgery of the hip and lumbar spine and concluded that procedures with a dose area product of <0.38 Gy m 2 would not exceed the corresponding effective dose limit [21].…”

Section: Discussionmentioning

confidence: 99%

Establishing the radiation risk from fluoroscopic-assisted arthroscopic surgery of the hip

Budd

Patchava

Khanduja

2012

International Orthopaedics (SICOT)

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Purpose The purpose of the study was to quantify patient exposure to ionising radiation during fluoroscopic-assisted arthroscopic surgery of the hip, establish a risk profile of this exposure, and reassure patients of radiation safety during the procedure. Methods We retrospectively analysed the dose area products for 50 consecutive patients undergoing arthroscopic hip surgery by an experienced hip arthroscopic surgeon. The effective dose and organ dose were derived using a Monte Carlo program. Results The mean total fluoroscopy time was 1.10 minutes and the mean dose area product value was 297.2 cGycm 2 . We calculated the entrance skin dose to be 52 mGy to the area where the beam was targeted (81 cm 2 ). The mean effective dose for intra-operative fluoroscopy was 0.33 mSv, with a SD of 0.90 Sv. Conclusion This study confirms that fluoroscopic-assisted arthroscopic surgery of the hip is safe with a low maximum radiation dose and supports its continued use in preference to alternative imaging modalities.

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Occupational Exposure From Common Fluoroscopic Projections Used in Orthopaedic Surgery

Cited by 190 publications

References 17 publications

Clinical and radiographic outcomes of minimally invasive percutaneous pedicle screw placement with intraoperative CT (O-arm) image guidance navigation

Clinical and radiographic outcomes of minimally invasive percutaneous pedicle screw placement with intraoperative CT (O-arm) image guidance navigation

Ionising Radiation Exposure to Orthopaedic Trainees: The Effect of Sub-Specialty Training

Establishing the radiation risk from fluoroscopic-assisted arthroscopic surgery of the hip

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