title: Cervical spine imaging using standard C-arm fluoroscopy: patient and surgeon exposure to ionizing radiation.
abstract: METHODS
  A cadaveric cervical spine specimen is imaged with a standard C-arm fluoroscope during a simulated procedure. Patient and surgeon exposure to radiation is estimated by placing dosimeters at various locations in 3-dimensional space.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate radiation exposure to patient and surgeon when using C-arm fluoroscopy during a simulated cadaveric surgical procedure involving the cervical spine.
  
  
  BACKGROUND
  The use of mobile fluoroscopy has become commonplace in orthopaedics. With the current trend towards minimal access techniques, fluoroscopy has become requisite to achieving satisfactory outcomes. Studies have shown that spine surgeons may be at elevated risk for radiation exposure compared to other orthopaedists. Exposure while using C-arm fluoroscopy for procedures involving the pelvis, as well as thoracic and lumbar spine has been documented. However, there are no equivalent studies that evaluate exposure during cervical spine imaging.
  
  
  METHODS
  A standard OEC 9800 C-arm was used to image a prepared cadaveric cervical spine specimen, which was suspended on an adjustable platform. Film badge dosimeters were mounted at various positions and angles to detect direct and scatter radiation. Testing was conducted in various radiation dose mapping "scenarios." The configurations tested altered the proximity of the specimen and jig relative to the radiation source. We attempted to capture radiation exposure in various locations, from a best-case to a worst-case scenario, as may be realistically encountered in a procedural setting. RESULTS.: Potential exposure to the patient and surgeon were consistently measurable, and of concern. As the imaged specimen was positioned closer to the radiation source, exposure to the patient was markedly amplified. Exposure to the surgeon did not increase as dramatically. There was a great degree of variability in the exposure doses recorded by the peripheral dosimeters. Even dosimeters that were placed in the same plane diverged widely in their measured exposure. This highlights the influence of the shape of the imaged specimen on reflected scatter. Scatter radiation doses on both sides of the specimen were similar.
  
  
  CONCLUSIONS
  Care should be taken when working on both sides of the imaged subject. Considerable radiation exposure can be encountered when working with a C-arm fluoroscope if appropriate precautions are not observed. All appropriate radiation dose-reducing measures should be strictly enforced by the supervising physician to minimize risk to the patient and the medical team.
authors.affiliation: Department of Orthopedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Giordano
authors.forename: Judith F
authors.initials: JF
authors.lastname: Baumhauer
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Morgan
authors.forename: Glenn R
authors.initials: GR
authors.lastname: Rechtine
mesh_terms: D002574:Cervical Vertebrae / Q000528:radiation effects*; D005373:Film Dosimetry / Q000379:methods; D005471:Fluoroscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D016273:Occupational Exposure / Q000517:prevention & control; D010361:Patients; D010820:Physicians; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods; D011839:Radiation, Ionizing