title: Estimation of patient dose and associated radiogenic risks from fluoroscopically guided pedicle screw insertion.
abstract: METHODS
  An experimental model for the assessment of patient dose and associated radiogenic risks associated with pedicle screw internal fixation surgical procedures.
  
  
  OBJECTIVE
  To provide data for the accurate determination of patient effective dose, gonadal dose, and entrance skin dose from fluoroscopically assisted pedicle screw insertion procedures and to investigate the potential of both stochastic and deterministic radiogenic effects to occur following such procedures.
  
  
  BACKGROUND
  There is increased concern on radiation exposure of patients undergoing fluoroscopically guided interventional procedures.
  
  
  METHODS
  The cumulative screening time and dose area product, for each fluoroscopic projection used, were monitored in 20 patients undergoing pedicle screw internal fixation. The dose absorbed by each radiosensitive organ/tissue was determined from direct measurements obtained using an anthropomorphic phantom appropriately loaded with thermoluminescence dosimeters.
  
  
  RESULTS
  An average pedicle screw insertion procedure requires 1.2 minutes and 2.1 minutes of fluoroscopic exposure along anteroposterior and lateral projections, respectively, resulting in a dose area product of 232 cGy cm and 568 cGy cm, correspondingly. Gender-specific normalized data for the determination of effective, gonadal, and entrance skin dose to patients undergoing fluoroscopically guided pedicle screw internal fixation procedures were derived. The effective dose from an average procedure was 1.52 and 1.40 mSv and the gonadal dose 0.67 and 0.12 mGy for female and male patients, respectively. The average radiogenic risks for fatal cancer and genetic defects were 115 and 4 per million of patients treated, respectively. Induction of skin injuries might be induced when fluoroscopy along the lateral projection is highly extended and the source to skin distance is kept low.
  
  
  CONCLUSIONS
  Patient dose and radiogenic risks associated with an average pedicle screw internal fixation procedure are tolerable. However, for young patients with complex spinal disorders requiring extended fluoroscopy, radiogenic risks may be considerable. Present data may beused for estimation of effective dose, gonadal dose, and entrance skin exposure and associated radiogenic risks to patients undergoing fluoroscopically guided pedicle screw insertion in any institution.
authors.affiliation: Departments of Medical Physics, University of Crete, Faculty of Medicine, Iraklion, Crete, Greece. perisina@med.uoc.gr
authors.forename: Kostas
authors.initials: K
authors.lastname: Perisinakis
authors.forename: Nicholas
authors.initials: N
authors.lastname: Theocharopoulos
authors.forename: John
authors.initials: J
authors.lastname: Damilakis
authors.forename: Pavlos
authors.initials: P
authors.lastname: Katonis
authors.forename: George
authors.initials: G
authors.lastname: Papadokostakis
authors.forename: Alexandros
authors.initials: A
authors.lastname: Hadjipavlou
authors.forename: Nicholas
authors.initials: N
authors.lastname: Gourtsoyiannis
mesh_terms: D000328:Adult; D000367:Age Factors; D001863:Bone Screws; D004890:Erythema / Q000209:etiology; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology; D009928:Organ Specificity; D010053:Ovary / Q000528:radiation effects; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D015641:Radiography, Interventional / Q000009:adverse effects; D012306:Risk; D012867:Skin / Q000528:radiation effects; D013269:Stochastic Processes; D013737:Testis / Q000528:radiation effects; D013819:Thermoluminescent Dosimetry; D013904:Thoracic Vertebrae / Q000601:surgery