Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion.
METHODS
In vitro study to determine occupational radiation exposure during lumbar fluoroscopy.


OBJECTIVE
To assess radiation exposure to the spine surgeon during fluoroscopically assisted thoracolumbar pedicle screw placement.


BACKGROUND
Occupational radiation exposure during a variety of fluoroscopically assisted musculoskeletal procedures has been previously evaluated. No prior study has assessed fluoroscopy-related radiation exposure to the spine surgeon.


METHODS
Bilateral pedicle screw placement (T11-S1) was performed in six cadavers using lateral fluoroscopic imaging. Radiation dose rates to the surgeon's neck, torso, and dominant hand were measured with dosimeter badges and thermolucent dosimeter (TLD) rings. Radiation levels were also quantified at various distances from the dorsal lumbar surface using an ion chamber radiation survey meter.


RESULTS
The mean dose rate to the neck was 8.3 mrem/min. The dose rate to the torso was greatest when the surgeon was positioned ipsilateral to the beam source (53.3 mrem/min, compared with 2.2 mrem/min on the contralateral side). The average hand dose rate was 58.2 mrem/min. A significant increase in hand dose rate was associated with placement of screws ipsilateral to the beam source (P = 0.0005) and larger specimens (P = 0.0007). Radiation levels significantly decreased as distance from the beam source and dorsal body surface increased. The greatest levels of radiation were noted on the side where the primary radiograph beam entered the cadaver.


CONCLUSIONS
Fluoroscopically assisted thoracolumbar pedicle screw placement exposes the spine surgeon to significantly greater radiation levels than other, nonspinal musculoskeletal procedures that involve the use of a fluoroscope. In fact, dose rates are up to 10-12 times greater. Spine surgeons performing fluoroscopically assisted thoracolumbar procedures should monitor their annual radiation exposure. Measures to reduce radiation exposure and surgeon awareness of high-exposure body and hand positions are certainly called for.
Rampersaud
Y R
YR
Image-Guided Surgery Research Center, Memphis, Tennessee 38104, USA.
Foley
K T
KT
Shen
A C
AC
Williams
S
S
Solomito
M
M
D001863:Bone Screws; D002102:Cadaver; D005471:Fluoroscopy / Q000009:adverse effects* / Q000379:methods; D006225:Hand / Q000528:radiation effects; D016268:Internal Fixators; D009784:Occupational Diseases / Q000209:etiology* / Q000517:prevention & control; D016273:Occupational Exposure / Q000009:adverse effects* / Q000517:prevention & control; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology* / Q000517:prevention & control; D011874:Radiometry / Q000379:methods / Q000706:statistics & numerical data; D013123:Spinal Fusion / Q000145:classification / Q000295:instrumentation / Q000379:methods; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*