Department of Orthopedic Surgery, Division of Spine Surgery, Presbyterian/Weill Cornell Hospital, New York, NY, USA.
Spine (Phila Pa 1976). 2013 Jul 15;38(16):1386-92. doi: 10.1097/BRS.0b013e31828705ad.
Prospective in vivo radiation exposure study.
To assess surgeon exposure to ionizing radiation in the setting of lateral lumbar interbody fusion (LLIF).
Minimally invasive spine surgery relies heavily on image guidance. Rapid popularization of minimally invasive spine surgery procedures, such as LLIF, is appropriately accompanied by concern regarding occupational radiation exposure related to intraoperative fluoroscopy.
Optically stimulated luminescence technology dosimeters were used to record radiation exposure prospectively at 5 anatomic locations during 18 LLIF procedures: (1) eye, (2) thyroid, (3) chest, (4) axilla, and (5) gluteal region. Additionally, a ring dosimeter was worn during 13 of the LLIF cases.
Average fluoroscopy time was 88.7 ± 36.8 seconds and skin dose to the patient was 25.2 ± 21.1 mGy. The chest dosimeter protected by lead recorded the lowest readings per procedure (0.44 ± 0.49 mrem). The gluteal dosimeter recorded an average exposure of 2.31 ± 4.50 mrem and the dosimeter at the axilla recorded an average of 4.20 ± 7.76 mrem per procedure. Exposure to the thyroid and eye were 2.19 ± 2.07 mrem and 2.64 ± 2.76 mrem, respectively. With the exception of the gluteal region, dosimeter readings from all unprotected areas were significantly higher than those from the chest dosimeter (P < 0.0125). In the course of 13 procedures, 190 mrem of exposure to the hand was recorded by the ring dosimeters. More than 2700 LLIF procedures may be performed annually before occupational limits are exceeded.
Prolonged exposure to "low-level" radiation as an occupational risk remains a concern for medical personnel. Radiation exposures to unprotected, radiosensitive locations, such as the axilla or eye, are worrisome. However, following radiation safety guidelines, 2700 LLIF procedures can be performed per year before exceeding occupational dose limits. Adherence to radiation safety guidelines is necessary to avoid sequelae related to an invisible but potentially deadly risk of minimally invasive spine surgery procedures.
前瞻性体内辐射暴露研究。
评估侧路腰椎间融合术（LLIF）中外科医生的电离辐射暴露情况。
微创脊柱手术严重依赖图像引导。微创脊柱手术程序（如 LLIF）的快速普及，恰当地伴随着对术中透视相关职业辐射暴露的关注。
使用光激励发光技术剂量仪在 18 例 LLIF 手术的 5 个解剖部位（1）眼部、（2）甲状腺、（3）胸部、（4）腋窝和（5）臀区）进行前瞻性记录辐射暴露情况。此外，在 13 例 LLIF 病例中佩戴了环形剂量仪。
平均透视时间为 88.7±36.8 秒，患者皮肤剂量为 25.2±21.1mGy。胸部剂量仪受铅保护记录的每个程序读数最低（0.44±0.49mrem）。臀区剂量仪记录的平均暴露量为 2.31±4.50mrem，腋窝剂量仪记录的平均暴露量为每个程序 4.20±7.76mrem。甲状腺和眼部的暴露量分别为 2.19±2.07mrem 和 2.64±2.76mrem。除臀区外，所有未受保护区域的剂量计读数均明显高于胸部剂量计（P<0.0125）。在 13 例手术中，手部记录到 190mrem 的辐射暴露量。每年可能会进行超过 2700 例 LLIF 手术，才会超过职业限制。
作为职业风险的长期“低水平”辐射暴露仍然是医务人员关注的问题。对未受保护的、对辐射敏感的部位（如腋窝或眼睛）的辐射暴露令人担忧。然而，遵循辐射安全指南，每年可进行 2700 例 LLIF 手术，才会超过职业剂量限制。遵守辐射安全指南对于避免微创脊柱手术程序的潜在致命风险相关的后遗症是必要的。
