title: Radiation exposure to the surgeon during fluoroscopically assisted percutaneous vertebroplasty: a prospective study.
abstract: METHODS
  A prospective case control study design was conducted.
  
  
  OBJECTIVE
  The purpose of the current study was to determine the intraoperative radiation hazard to spine surgeons by occupational radiation exposure during percutaneous vertebroplasty and possible consequences with respect to radiation protection.
  
  
  BACKGROUND
  The development of minimally invasive surgery techniques has led to an increasing number of fluoroscopically guided procedures being done percutaneously such as vertebroplasty, which is the percutaneous cement augmentation of vertebral bodies.
  
  
  METHODS
  Three months of occupational dose data for two spine surgeons was evaluated measuring the radiation doses to the thyroid gland, the upper extremities, and the eyes during vertebroplasty.
  
  
  RESULTS
  The annual risk of developing a fatal cancer of the thyroid is 0.0025%, which means a very small to small risk. The annual morbidity (the risk of developing a cancer including nonfatal ones) is 0.025%, which already means a small to medium risk. The dose for the eye lens was about 8% of the threshold dose to develop a radiation induced cataract (150 mSv); therefore, the risk is very low but not negligible. The doses measured for the skin are 10% of the annual effective dose limit (500 mSv) recommended by the ICRP (International Commission on Radiologic Protection); therefore, the annual risk for developing a fatal skin cancer is very low.
  
  
  CONCLUSIONS
  While performing percutaneous vertebroplasty, the surgeon is exposed to a significant amount of radiation. Proper surgical technique and shielding devices to decrease potentially high morbidity are mandatory. Training in radiation protection should be an integral part of the education for all surgeons using minimally invasive radiologic-guided interventional techniques.
authors.affiliation: Department of Orthopaedic Surgery, Inselspital, University of Berne, Switzerland.
authors.forename: Roger
authors.initials: R
authors.lastname: Harstall
authors.forename: Paul F
authors.initials: PF
authors.lastname: Heini
authors.forename: Roberto L
authors.initials: RL
authors.lastname: Mini
authors.forename: Rene
authors.initials: R
authors.lastname: Orler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000528:radiation effects; D016022:Case-Control Studies; D002386:Cataract / Q000209:etiology; D005123:Eye / Q000528:radiation effects; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009381:Neoplasms, Radiation-Induced / Q000209:etiology; D016273:Occupational Exposure; D019637:Orthopedic Procedures; D010820:Physicians; D011446:Prospective Studies; D011827:Radiation; D011829:Radiation Dosage; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000209:etiology; D013131:Spine / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D013961:Thyroid Gland / Q000528:radiation effects; D013964:Thyroid Neoplasms / Q000209:etiology