Hoffler C Edward, Ilyas Asif M
Rothman Institute, Thomas Jefferson University, 1025 Walnut Street, College Building, Room 516, Philadelphia, PA 19107. E-mail address for C.E. Hoffler:
J Bone Joint Surg Am. 2015 May 6;97(9):721-5. doi: 10.2106/JBJS.N.00839.
While traditional intraoperative fluoroscopy protection relies on thyroid shields and aprons, recent data suggest that the surgeon's eyes and hands receive more exposure than previously appreciated. Using a distal radial fracture surgery model, we examined (1) radiation exposure to the eyes, thyroid, chest, groin, and hands of a surgeon mannequin; (2) the degree to which shielding equipment can decrease exposure; and (3) how exposure varies with fluoroscopy unit size.
An anthropomorphic model was fit with radiation-attenuating glasses, a thyroid shield, an apron, and gloves. "Exposed" thermoluminescent dosimeters overlaid the protective equipment at the eyes, thyroid, chest, groin, and index finger while "shielded" dosimeters were placed beneath the protective equipment. Fluoroscopy position and settings were standardized. The mini-c-arm milliampere-seconds were fixed based on the selection of the kilovolt peak (kVp). Three mini and three standard c-arms scanned a model of the patient's wrist continuously for fifteen minutes each. Ten dosimeter exposures were recorded for each c-arm.
Hand exposure averaged 31 μSv/min (range, 22 to 48 μSv/min), which was 13.0 times higher than the other recorded exposures. Eye exposure averaged 4 μSv/min, 2.2 times higher than the mean thyroid, chest, and groin exposure. Gloves reduced hand exposure by 69.4%. Glasses decreased eye exposure by 65.6%. There was no significant difference in exposure between mini and standard fluoroscopy.
Surgeons' hands receive the most radiation exposure during distal radial plate fixation under fluoroscopy. There was a small but insignificant difference in mean exposure between standard fluoroscopy and mini-fluoroscopy, but some standard units resulted in lower exposure than some mini-units. On the basis of these findings, we recommend routine protective equipment to mitigate exposure to surgeons' hands and eyes, in addition to the thyroid, chest, and groin, during fluoroscopy procedures.
虽然传统的术中透视防护依赖于甲状腺防护罩和防护围裙，但最近的数据表明，外科医生的眼睛和手部受到的辐射暴露比之前认为的更多。我们使用桡骨远端骨折手术模型，研究了：（1）外科医生人体模型的眼睛、甲状腺、胸部、腹股沟和手部的辐射暴露情况；（2）防护设备能降低暴露的程度；（3）暴露量如何随透视设备大小而变化。
一个人体模型佩戴了辐射衰减眼镜、甲状腺防护罩、防护围裙和手套。“暴露”热释光剂量计覆盖在眼睛、甲状腺、胸部、腹股沟和食指处的防护设备上，而“屏蔽”剂量计则放置在防护设备下方。透视位置和设置标准化。根据千伏峰值（kVp）的选择固定迷你C型臂的毫安秒。三台迷你C型臂和三台标准C型臂分别对患者手腕模型连续扫描15分钟。每台C型臂记录10次剂量计暴露数据。
手部暴露平均为31微希沃特/分钟（范围为22至48微希沃特/分钟），比其他记录的暴露量高13.0倍。眼部暴露平均为4微希沃特/分钟，比甲状腺、胸部和腹股沟的平均暴露量高2.2倍。手套使手部暴露减少了69.4%。眼镜使眼部暴露减少了65.6%。迷你透视和标准透视之间的暴露量没有显著差异。
在透视下进行桡骨远端钢板固定时，外科医生的手部受到的辐射暴露最多。标准透视和迷你透视的平均暴露量存在微小但不显著的差异，但一些标准设备导致的暴露量低于一些迷你设备。基于这些发现，我们建议在透视程序中，除了对甲状腺、胸部和腹股沟进行防护外，常规使用防护设备以减轻外科医生手部和眼睛的暴露。
