title: Radiation exposure to the surgeon and the patient during kyphoplasty.
abstract: METHODS
  Prospective study of patients who underwent single or multilevel kyphoplasty for vertebral fractures.
  
  
  OBJECTIVE
  To quantify the radiation exposure to the surgeon and to the patient during kyphoplasty, and also to provide a procedural algorithm that effectively minimizes the radiation exposure to the surgeon during any fluoroscopic-guided procedure.
  
  
  BACKGROUND
  Spine surgeons who perform minimally invasive procedures often employ fluoroscopy for intraoperative navigation.
  
  
  METHODS
  Twenty-seven patients were enrolled. Two fluoroscopes (1 anterior/posterior and 1 lateral) were used for localization, navigation, and monitoring cement flow. All surgeons wore thyroid shields and lead aprons. The dose of radiation exposure was measured by dosimeter badges. One badge was attached to each patient. The surgeons wore 3 badges: under the thyroid shield (protected), under the lead apron over the left chest (protected), and outside the lead apron over the left chest (unprotected). A thermoluminescent ring dosimeter was worn on the right hand for 18 cases, and on the left hand for 9 cases.
  
  
  RESULTS
  The exposure time was 5.7+/-2.0 minutes/vertebra for a single level (n=10), 3.9+/-0.8 minutes/vertebra for a 2 level (n=9), 2.9+/-1.2 minutes/vertebra for a 3 level kypholasty (n=8). The exposure time of single level kyphoplasy was significantly different from that of multilevel kyphoplasy (2 level, P=0.040; 3 level, P=0.002). Surgeon exposure as measured by the protected dosimeter was less than the minimum reportable dose (<0.010 mSv). Exposure as measured by the unprotected dosimeter, which is equivalent to deep whole body exposure was 0.248+/-0.170 mSv/vertebra. The eye exposure was 0.271+/-0.200 mSv/vertebra, and the shallow exposure (hand/skin) was 0.273+/-0.200 mSv/vertebra. The hand exposure was 1.744+/-1.173 mSv/vertebra.
  
  
  CONCLUSIONS
  Without eye or hand protection, the total radiation exposure dose to these areas would exceed the occupational exposure limit after 300 cases per year. Surgeons should wear lead lined glasses and keep their hands out of the radiation beam.
authors.affiliation: Spine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. mrozt@ccf.org
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
authors.forename: Takayuki
authors.initials: T
authors.lastname: Yamashita
authors.forename: William J
authors.initials: WJ
authors.lastname: Davros
authors.forename: Isador H
authors.initials: IH
authors.lastname: Lieberman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005257:Fellowships and Scholarships; D005373:Film Dosimetry; D005471:Fluoroscopy / Q000009:adverse effects*; D013502:General Surgery; D006801:Humans; D007396:Internship and Residency; D007432:Intraoperative Period; D008503:Medical Staff; D008875:Middle Aged; D016273:Occupational Exposure; D011446:Prospective Studies; D011829:Radiation Dosage; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D054854:Vertebroplasty