Fluoroscopically guided percutaneous vertebroplasty: assessment of radiation doses and implementation of procedural routines to reduce operator exposure.
BACKGROUND
Percutaneous vertebroplasty (PVP) is a fluoroscopically guided procedure for the treatment of painful vertebral compression fractures and metastases. Routine legal personal dosimetry repeatedly showed dosimeter doses exceeding 1 mSv/month for the only radiologist performing PVP at our hospital. Based on the nature of the procedure, this raised concern about potentially high doses to the eyes and fingers.


OBJECTIVE
To assess radiation doses to the operator, and to evaluate possibilities for dose reduction.


METHODS
Measurements of scattered radiation in simulated thoracic and lumbar PVP procedures were performed using two anatomical phantoms--thorax and lower trunk--and a radiation survey meter. The standard position of the operator was determined as being 50 cm from the irradiated area of the phantom. The protection ability of lead-free gloves was evaluated during the simulations. Operator doses to fingers and eyes during 10 clinical PVP procedures performed by a single operator were measured, and the annual dose was calculated. Routine personal dosimetry was performed using thermoluminescent dosimeter (TLD) badges beneath the lead apron, and doses to fingers and eyes were measured with small TLD tablets.


RESULTS
During simulations, the measured operator dose rate arising from lateral fluoroscopy at the thorax and lumbar level was reduced by a factor of 4-5 when the X-ray tube was moved from the operator's side of the patient to the opposite side. Wearing protective gloves reduced radiation dose to the hands by 30-40%. The mean doses arising from the 10 clinical PVP procedures to the right and left hands, using protection gloves, were 2.0 mSv and 4.8 mSv, respectively. The mean dose to the eyes was 0.23 mSv. The mean effective dose to the patients was 12 mSv.


CONCLUSIONS
Placing the X-ray tube on the side of the patient opposite to the operator and the use of radiation protection gloves significantly reduces radiation exposure to the operator. In phantom simulations, the dose was reduced by a factor of 4-5. Knowledge of fluoroscopy equipment, radiation physics, and protection is essential in order to reduce exposure.
Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden.
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von Wrangel
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Cederblad
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Rodriguez-Catarino
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D017575:Gloves, Protective; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000517:prevention & control*; D019047:Phantoms, Imaging; D011482:Protective Devices; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000517:prevention & control*; D011834:Radiation Monitoring / Q000379:methods / Q000706:statistics & numerical data; D015641:Radiography, Interventional; D016103:Spinal Fractures / Q000628:therapy; D013679:Technology, Radiologic; D054854:Vertebroplasty / Q000379:methods*