Protecting Surgeons' Fingers from Radiation Exposure during Lumbosacral Selective Nerve Root Block

Abstract

Introduction: Fluoroscopy-guided selective nerve root block (SNRB) is useful for the diagnosis and treatment of nerve root pain. However, the procedure exposes the surgeon's hands to radiation. Therefore, the purpose of this randomized prospective study was to assess the radiation exposure per unit time of the surgeon's fingers during performance of a lumbosacral SNRB and to calculate the annual exposure time limits for four hand-protection methods. Methods: We prospectively recruited patients scheduled for an SNRB and measured the radiation exposure using a ringtype passive radiation dosimetry device attached to the distal phalanx of the index finger of the hand performing the needle placement. Patients were randomly divided into the following four groups: a) the direct exposure group, b) the 0.03-mmPb glove group, c) the 0.25-mmPb glove group, and d) the forceps group (in which the needle was held using forceps such that the fingers did not enter the irradiation field). Results: We recruited 40 consecutive patients (16 men and 24 women), with a mean age of 69 years. In all cases, SNRB was successfully performed without complications. The average exposure per hour for each of the four groups was as follows: 0.67 ± 0.56 mSv/s in the direct exposure group, 0.12 ± 0.07 mSv/s in the 0.03-mmPb glove group, 0.019 ± 0.02 mSv/s in the 0.25-mmPb glove group, and 0.001 ± 0.004 mSv/s in the forceps group (p < 0.01). The average annual exposure time limit was 12.4 min in the direct exposure group, 67.9 min in the 0.03-mmPb glove group, 7.5 h in the 0.25-mmPb glove group, and 5.0 days in the forceps group. Conclusions: Using a radiation reduction glove or forceps greatly decreased the radiation exposure and increased the annual exposure time limit for SNRB.

A novel technique using ultrasonography in upper airway management after anterior cervical decompression and fusion

“…Plain radiography is useful for predicting the risk of dyspnea by allowing comparison of the PST thickness before and after surgery. However, it requires frequent radiation exposure and is inconvenient [ 4 , 7 – 9 ]. Therefore, we aimed to overcome these problems using ultrasonography to evaluate the PST and upper airway after ACDF.…”

“…When risk factors are present, surgeons traditionally monitor the condition of the prevertebral soft tissue (PST) by examining cervical spine lateral radiographs taken from postoperative day 1 to day 10 [ 7 , 8 ]. However, radiographic evaluation is inconvenient and unsafe as it requires transporting the patient or the use of a portable radiography device and exposes the patient to radiation [ 9 ].…”

A Novel Technique Using Ultrasonography in Upper Airway Management After Anterior Cervical Decompression and Fusion

“…[7,8] However, radiographic evaluation is inconvenient and unsafe as it requires transporting the patient or the portable radiography device and exposes the patient to radiation. [9] These problems could be circumvented using an ultrasound device to evaluate the PST and upper airway after ACDF. Ultrasound can be quickly performed at the bedside, and patients are not exposed to radiation.…”