title: Surgeons' exposure to radiation in single- and multi-level minimally invasive transforaminal lumbar interbody fusion; a prospective study.
abstract: Although minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has widely been developed in patients with lumbar diseases, surgeons risk exposure to fluoroscopic radiation. However, to date, there is no studies quantifying the effective dose during MIS-TLIF procedure, and the radiation dose distribution is still unclear. In this study, the surgeons' radiation doses at 5 places on the bodies were measured and the effective doses were assessed during 31 consecutive 1- to 3-level MIS-TLIF surgeries. The operating surgeon, assisting surgeon, and radiological technologist wore thermoluminescent dosimeter on the unshielded thyroid, chest, genitals, right middle finger, and on the chest beneath a lead apron. The doses at the lens and the effective doses were also calculated. Mean fluoroscopy times were 38.7, 53.1, and 58.5 seconds for 1, 2, or 3 fusion levels, respectively. The operating surgeon's mean exposures at the lens, thyroid, chest, genitals, finger, and the chest beneath the shield, respectively, were 0.07, 0.07, 0.09, 0.14, 0.32, and 0.05 mSv in 1-level MIS-TLIF; 0.07, 0.08, 0.09, 0.18, 0.34, and 0.05 mSv in 2-level; 0.08, 0.09, 0.14, 0.15, 0.36, and 0.06 mSv in 3-level; and 0.07, 0.08, 0.10, 0.15, 0.33, and 0.05 mSv in all cases. Mean dose at the operating surgeon's right finger was significantly higher than other measurements parts (P<0.001). The operating surgeon's effective doses (0.06, 0.06, and 0.07 mSv for 1, 2, and 3 fusion levels) were low, and didn't differ significantly from those of the assisting surgeon or radiological technologist. Revision MIS-TLIF was not associated with higher surgeons' radiation doses compared to primary MIS-TLIF. There were significantly higher surgeons' radiation doses in over-weight than in normal-weight patients. The surgeons' radiation exposure during MIS-TLIF was within the safe level by the International Commission on Radiological Protection's guidelines. The accumulated radiation exposure, especially to surgeon's hands, should be carefully monitored.
authors.affiliation: Department of Orthopaedic Surgery, Nerima General Hospital, Tokyo, Japan; Society for Minimally invasive spine Stabilization (Clinical research group).
authors.forename: Haruki
authors.initials: H
authors.lastname: Funao
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan; Society for Minimally invasive spine Stabilization (Clinical research group).
authors.forename: Ken
authors.initials: K
authors.lastname: Ishii
authors.affiliation: Department of Radiology, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Suketaka
authors.initials: S
authors.lastname: Momoshima
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan; Society for Minimally invasive spine Stabilization (Clinical research group).
authors.forename: Akio
authors.initials: A
authors.lastname: Iwanami
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan; Society for Minimally invasive spine Stabilization (Clinical research group).
authors.forename: Naobumi
authors.initials: N
authors.lastname: Hosogane
authors.affiliation: Advanced Therapy for Spine and Spinal Cord Disorders, Keio University, Tokyo, Japan; Society for Minimally invasive spine Stabilization (Clinical research group).
authors.forename: Kota
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Toyama
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Morio
authors.initials: M
authors.lastname: Matsumoto
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D016273:Occupational Exposure / Q000032:analysis*; D011446:Prospective Studies; D011829:Radiation Dosage; D011834:Radiation Monitoring; D011835:Radiation Protection / Q000295:instrumentation; D012449:Safety; D013123:Spinal Fusion / Q000379:methods*; D066231:Surgeons / Q000706:statistics & numerical data*
references.citation: Br J Radiol. 2006 Aug;79(944):644-51
references.pmid: 16641414
references.citation: Eur Spine J. 2012 Nov;21(11):2265-70
references.pmid: 22453894
references.citation: J Spinal Disord Tech. 2009 May;22(3):207-13
references.pmid: 19412024
references.citation: Br J Radiol. 2003 Jun;76(906):406-13
references.pmid: 12814927
references.citation: J Neurosurg. 1953 Mar;10(2):154-68
references.pmid: 13035484
references.citation: Am J Phys Med Rehabil. 2011 Nov;90(11):908-12
references.pmid: 21952213
references.citation: Injury. 1998 Jul;29(6):461-8
references.pmid: 9813705
references.citation: Genome Integr. 2010 Sep 12;1(1):13
references.pmid: 20831828
references.citation: World Neurosurg. 2012 Jul;78(1-2):178-84
references.pmid: 22120269
references.citation: Spine J. 2008 Jul-Aug;8(4):584-90
references.pmid: 18586198
references.citation: Ann ICRP. 2007;37(2-4):1-332
references.pmid: 18082557
references.citation: Neurosurg Focus. 2001 Apr 15;10(4):E10
references.pmid: 16732626
references.citation: J Am Acad Orthop Surg. 2005 Jan-Feb;13(1):69-76
references.pmid: 15712984
references.citation: Spine (Phila Pa 1976). 2000 Jun 15;25(12):1538-41
references.pmid: 10851103
references.citation: J Spinal Disord Tech. 2002 Feb;15(1):31-8
references.pmid: 11891448
references.citation: Neurosurgery. 2002 Nov;51(5 Suppl):S166-81
references.pmid: 12234445
references.citation: Radiology. 1996 Jul;200(1):45-8
references.pmid: 8657942
references.citation: Radiat Prot Dosimetry. 2008;129(1-3):333-9
references.pmid: 18483007
references.citation: J Am Coll Cardiol. 2007 Jul 17;50(3):234-42
references.pmid: 17631216
references.citation: Eur J Dermatol. 2011 Sep-Oct;21(5):821-2
references.pmid: 21768058
references.citation: Eur Spine J. 2011 Apr;20(4):623-8
references.pmid: 20927557
references.citation: Radiat Prot Dosimetry. 2009 Sep;136(3):140-57
references.pmid: 19759087
references.citation: Neurosurg Focus. 2013 Aug;35(2):E8
references.pmid: 23905959
references.citation: Eur Spine J. 2005 Nov;14(9):887-94
references.pmid: 16151713
references.citation: J Bone Joint Surg Am. 2003 Sep;85(9):1698-703
references.pmid: 12954827
references.citation: Neurosurgery. 2001 Mar;48(3):569-74; discussion 574-5
references.pmid: 11270547
references.citation: J Spinal Disord Tech. 2011 Dec;24(8):479-84
references.pmid: 21336176
references.citation: Arch Dermatol. 1996 Jun;132(6):663-7
references.pmid: 8651716
references.citation: Ann ICRP. 1991;21(1-3):1-201
references.pmid: 2053748
references.citation: J Spinal Disord Tech. 2005 Feb;18 Suppl:S1-6
references.pmid: 15699793
references.citation: Radiology. 1996 Jul;200(1):24-5
references.pmid: 8657919
references.citation: J Neurosurg Spine. 2008 Dec;9(6):570-3
references.pmid: 19035750
references.citation: Spine (Phila Pa 1976). 2011 Feb 1;36(3):255-60
references.pmid: 20736891
references.citation: Spine (Phila Pa 1976). 2000 Oct 15;25(20):2637-45
references.pmid: 11034650
references.citation: Z Orthop Ihre Grenzgeb. 1982 May-Jun;120(3):343-7
references.pmid: 7113376
references.citation: Minim Invasive Neurosurg. 2011 Feb;54(1):33-7
references.pmid: 21506066
references.citation: Br J Radiol. 1993 Oct;66(790):899-901
references.pmid: 8220973