Chapman Talia, Martin Dennis P, Williamson Christopher, Tinsley Brian, Wang Mark L, Ilyas Asif M
1 The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Hand (N Y). 2018 Sep;13(5):552-557. doi: 10.1177/1558944717715139. Epub 2017 Jun 23.
The risk of occupational radiation exposure to the surgeon associated with the use of a mini C-arm has yet to reach a wide consensus. Using a distal radius fracture surgery model, we tested the hypothesis that radiation exposure to the surgeon's critical body parts is independent of mini C-arm configuration.
An anthropomorphic mannequin (representing the upper body of a 60" male surgeon) was seated at a hand table as if operating on a volar-plated wrist Sawbone model. Thermoluminescent dosimeters measured radiation exposure to the surgeon's eyes, thyroid, chest, hand, and groin from a mini C-arm fluoroscopy unit in 3 commonly used configurations: vertical (source above table), inverted (source below table), and horizontal (with beam parallel to table surface). The fluoroscope scanned the wrist model for 15 continuous minutes in triplicate for each orientation.
Radiation to the hand was significantly greatest in all mini C-arm positions compared with all other anatomic sites irrespective of C-arm position. Hand radiation exposure was greatest in the horizontal position (2887.09 mrem), versus the vertical and inverted positions (59.79 mrem, 31.10 mrem, P < .001). Eye radiation exposure was significantly greater in the inverted position (2.33 mrem) compared with the vertical (0.67 mrem, P = .024), and horizontal positions (0.33 mrem, P = .012). No significant difference in radiation exposure was found at the thyroid, chest, and groin sites, at each of the 3 C-arm configurations.
The model's hand received almost 1000 times more radiation exposure than all other anatomic sites with statistically greatest radiation exposure sustained in the horizontal position. Eye radiation exposure with the C-arm in the inverted position (below the table) was also significantly greater.
与使用小型C形臂相关的外科医生职业辐射暴露风险尚未达成广泛共识。我们使用桡骨远端骨折手术模型，检验了外科医生关键身体部位的辐射暴露与小型C形臂配置无关这一假设。
一个人体模型（代表一名身高60英寸男性外科医生的上半身）坐在手术台上，就像在对一个掌侧钢板固定的腕部Sawbone模型进行手术一样。热释光剂量计测量了小型C形臂荧光透视设备在3种常用配置下对外科医生眼睛、甲状腺、胸部、手部和腹股沟的辐射暴露：垂直（源在手术台上方）、倒置（源在手术台下方）和平行（光束与手术台表面平行）。荧光透视仪对腕部模型进行15分钟的连续扫描，每种方向重复3次。
与所有其他解剖部位相比，无论C形臂处于何种位置，手部在所有小型C形臂位置接受的辐射均显著最大。手部辐射暴露在水平位置最大（2887.09毫雷姆），而垂直和倒置位置分别为59.79毫雷姆、31.10毫雷姆（P < 0.001）。与垂直位置（0.67毫雷姆，P = 0.024）和平行位置（0.33毫雷姆，P = 0.012）相比，倒置位置的眼睛辐射暴露显著更高（2.33毫雷姆）。在3种C形臂配置下，甲状腺、胸部和腹股沟部位的辐射暴露没有显著差异。
该模型的手部接受的辐射暴露几乎比所有其他解剖部位多1000倍，水平位置的辐射暴露在统计学上最大。C形臂处于倒置位置（手术台下方）时眼睛的辐射暴露也显著更高。
