Harrison Farber S, Nayar Gautam, Desai Rupen, Reiser Elizabeth W, Byrd Sarah A, Chi Deborah, Idler Cary, Isaacs Robert E
Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC, 27710, USA.
Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
Eur Spine J. 2018 Aug;27(8):1911-1917. doi: 10.1007/s00586-018-5653-6. Epub 2018 Jun 8.
Radiation exposure is a necessary component of minimally invasive spine procedures to augment limited visualization of anatomy. The surgeon's exposure to ionizing radiation is not easily recognizable without a digital dosimeter-something few surgeons have access to. The aim of this study was to identify an easy alternative method that uses the available radiation dose data from the C-arm to accurately predict physician exposure.
The senior surgeon wore a digital dosimeter during all minimally invasive spine fusion procedures performed over a 12-month period. Patient demographics, procedure information, and radiation exposure throughout the procedure were recorded.
Fifty-five minimally invasive spine fusions utilizing 330 percutaneous screws were included. Average radiation dose was 0.46 Rad/screw to the patient. Average radiation exposure to the surgeon was 1.06 ± 0.71 μSv/screw, with a strong positive correlation (r = 0.77) to patient dose. The coefficient of determination (r) was 0.5928, meaning almost two-thirds of the variability in radiation exposure to the surgeon is explained by radiation exposure to the patient.
Intra-operative radiation exposure to the patient, which is easily identifiable as a continuously updated fluoroscopic monitor, is a reliable predictor of radiation exposure to the surgeon during percutaneous screw placement in minimally invasive spinal fusion surgery and therefore can provide an estimate of exposure without the use of a dosimeter. With this, a surgeon can better understand the magnitude of their exposure on a case-by-case basis rather than on a quarterly basis, or more likely, not at all. These slides can be retrieved under Electronic Supplementary Material.
在微创脊柱手术中，辐射暴露是增强有限解剖结构可视化的必要组成部分。若无数字剂量仪，外科医生所受的电离辐射不易察觉，而很少有外科医生能够使用数字剂量仪。本研究的目的是确定一种简便的替代方法，该方法利用C形臂现有的辐射剂量数据来准确预测医生的辐射暴露情况。
在为期12个月的所有微创脊柱融合手术过程中，主刀医生佩戴数字剂量仪。记录患者的人口统计学信息、手术信息以及整个手术过程中的辐射暴露情况。
纳入了55例使用330枚经皮螺钉的微创脊柱融合手术。患者平均辐射剂量为0.46拉德/枚螺钉。外科医生的平均辐射暴露量为1.06±0.71微希沃特/枚螺钉，与患者剂量呈强正相关（r = 0.77）。决定系数（r）为0.5928，这意味着外科医生辐射暴露变异性的近三分之二可由患者的辐射暴露来解释。
术中患者的辐射暴露可通过持续更新的荧光透视监视器轻松识别，它是微创脊柱融合手术中经皮螺钉置入过程中外科医生辐射暴露的可靠预测指标，因此无需使用剂量仪即可估算暴露量。据此，外科医生能够逐例更好地了解自身暴露的程度，而非按季度了解，或者更有可能的是，根本无法了解。这些幻灯片可在电子补充材料中获取。
