Yamashita Kazuta, Higashino Kosaku, Hayashi Hiroaki, Hayashi Fumio, Fukui Yoshihiro, Sairyo Koichi
Departments of Orthopedics (K.Y., K.H., F.H., and K.S.), Biomedical Science and Technology (H.H.), and Anatomy (Y.F.), Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
JB JS Open Access. 2017 Dec 19;2(4):e0039. doi: 10.2106/JBJS.OA.17.00039. eCollection 2017 Dec 28.
Awareness of the harmful effects of long-term low-dose radiation is rising. Many studies have assessed both patient and physician exposure to radiation in association with the use of fluoroscopy in the operating room. However, to our knowledge, previous studies have not assessed, in a detailed fashion, the reduction in radiation exposure that pulsation and collimation provide.
Seven fresh cadavers were irradiated for 5 minutes with C-arm fluoroscopy with use of standard x-ray and pulsed and collimated x-ray beams. The x-ray sources were placed under the table, over the table, and lateral to the table. Radiation exposure doses were measured at different points, such as the center of the radiation field on the cadaver as well as at the locations of the surgeon's hand and thyroid gland. In addition, Monte Carlo simulation (a physics equation to predict exposure) was performed to estimate the dose reduction and to confirm the experimental results.
The radiation exposure doses associated with the use of pulsed fluoroscopy (8 times per second) were reduced by approximately 30% for the patient and by approximately 70% for the surgeon's hand and thyroid gland as compared with those associated with the use of continuous fluoroscopy. The radiation exposure doses associated with the use of collimated beams were reduced to approximately 65% for the surgeon's hand and thyroid gland as compared with those associated with the use of non-collimated fluoroscopy. These results were consistent with the simulation, and the phenomena could be appropriately explained by physics.
The present study revealed the effectiveness of pulsed and collimated x-ray beams in reducing radiation exposure doses resulting from C-arm fluoroscopy. Surgeons should consider using the techniques of pulsed fluoroscopy and collimation to protect patients and themselves from radiation.
This study presents data regarding the reduction of radiation exposure provided by pulsed fluoroscopy and collimation.
人们对长期低剂量辐射的有害影响的认识正在提高。许多研究评估了患者和医生在手术室使用荧光透视时的辐射暴露情况。然而，据我们所知，以前的研究尚未详细评估脉动和准直所带来的辐射暴露减少情况。
使用标准X射线、脉冲X射线束和准直X射线束，通过C形臂荧光透视对7具新鲜尸体进行5分钟的照射。X射线源分别置于手术台下方、上方和侧面。在不同点测量辐射暴露剂量，如尸体上辐射场的中心以及外科医生手部和甲状腺的位置。此外，进行了蒙特卡罗模拟（一种预测暴露的物理方程）以估计剂量减少并确认实验结果。
与连续荧光透视相比，使用脉冲荧光透视（每秒8次）时，患者的辐射暴露剂量降低了约30%，外科医生手部和甲状腺的辐射暴露剂量降低了约70%。与使用非准直荧光透视相比，使用准直光束时，外科医生手部和甲状腺的辐射暴露剂量降低至约65%。这些结果与模拟结果一致，并且这些现象可以用物理学进行适当解释。
本研究揭示了脉冲和准直X射线束在降低C形臂荧光透视产生的辐射暴露剂量方面的有效性。外科医生应考虑使用脉冲荧光透视和准直技术来保护患者和自身免受辐射。
本研究提供了关于脉冲荧光透视和准直所带来的辐射暴露减少的数据。
