Rampersaud Y R, Foley K T, Shen A C, Williams S, Solomito M
Image-Guided Surgery Research Center, Memphis, Tennessee 38104, USA.
Spine (Phila Pa 1976). 2000 Oct 15;25(20):2637-45. doi: 10.1097/00007632-200010150-00016.
In vitro study to determine occupational radiation exposure during lumbar fluoroscopy.
To assess radiation exposure to the spine surgeon during fluoroscopically assisted thoracolumbar pedicle screw placement.
Occupational radiation exposure during a variety of fluoroscopically assisted musculoskeletal procedures has been previously evaluated. No prior study has assessed fluoroscopy-related radiation exposure to the spine surgeon.
Bilateral pedicle screw placement (T11-S1) was performed in six cadavers using lateral fluoroscopic imaging. Radiation dose rates to the surgeon's neck, torso, and dominant hand were measured with dosimeter badges and thermolucent dosimeter (TLD) rings. Radiation levels were also quantified at various distances from the dorsal lumbar surface using an ion chamber radiation survey meter.
The mean dose rate to the neck was 8.3 mrem/min. The dose rate to the torso was greatest when the surgeon was positioned ipsilateral to the beam source (53.3 mrem/min, compared with 2.2 mrem/min on the contralateral side). The average hand dose rate was 58.2 mrem/min. A significant increase in hand dose rate was associated with placement of screws ipsilateral to the beam source (P = 0.0005) and larger specimens (P = 0.0007). Radiation levels significantly decreased as distance from the beam source and dorsal body surface increased. The greatest levels of radiation were noted on the side where the primary radiograph beam entered the cadaver.
Fluoroscopically assisted thoracolumbar pedicle screw placement exposes the spine surgeon to significantly greater radiation levels than other, nonspinal musculoskeletal procedures that involve the use of a fluoroscope. In fact, dose rates are up to 10-12 times greater. Spine surgeons performing fluoroscopically assisted thoracolumbar procedures should monitor their annual radiation exposure. Measures to reduce radiation exposure and surgeon awareness of high-exposure body and hand positions are certainly called for.
一项体外研究，以确定腰椎荧光透视检查期间的职业辐射暴露情况。
评估在荧光透视辅助下进行胸腰椎椎弓根螺钉置入时脊柱外科医生所受到的辐射暴露。
先前已对各种荧光透视辅助的肌肉骨骼手术中的职业辐射暴露情况进行了评估。此前尚无研究评估脊柱外科医生与荧光透视相关的辐射暴露情况。
使用侧位荧光透视成像技术，在六具尸体上进行双侧椎弓根螺钉置入（T11-S1）。使用剂量计徽章和热释光剂量计（TLD）环测量外科医生颈部、躯干和优势手所接受的辐射剂量率。还使用离子室辐射检测仪在距腰椎背面不同距离处对辐射水平进行了量化。
颈部的平均剂量率为8.3毫雷姆/分钟。当外科医生位于射线源同侧时，躯干的剂量率最高（53.3毫雷姆/分钟，而对侧为2.2毫雷姆/分钟）。手部的平均剂量率为58.2毫雷姆/分钟。手部剂量率的显著增加与在射线源同侧置入螺钉（P = 0.0005）以及标本较大（P = 0.0007）有关。随着与射线源和身体背面距离的增加，辐射水平显著降低。在主射线束进入尸体的一侧观察到最高的辐射水平。
与其他涉及使用荧光透视仪的非脊柱肌肉骨骼手术相比，荧光透视辅助下的胸腰椎椎弓根螺钉置入使脊柱外科医生受到的辐射水平显著更高。事实上，剂量率高达10至12倍。进行荧光透视辅助胸腰椎手术的脊柱外科医生应监测其年度辐射暴露情况。确实需要采取措施减少辐射暴露，并提高外科医生对高暴露身体部位和手部位置的认识。
