Malik Azeem Tariq, Rai Hamid Hussain, Lakdawala Riaz Hussain, Noordin Shahryar
Department of Orthopedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Neurosurgery, University of Buffalo, Buffalo, NY, USA.
Orthop Rev (Pavia). 2019 Mar 12;11(1):7667. doi: 10.4081/or.2019.7667. eCollection 2019 Feb 26.
With an increasing use of intraoperative fluoroscopy in operating rooms worldwide, the topic of radiation exposure has become a major concern among hospital staff, doctors and patients alike. Since fluoroscopy has become an integral part in orthopedic intraoperative management, we sought to identify whether surgeon grade or experience plays a role in the amount of radiation used and consequently exposed. We performed a systematic review examining the association between surgeon experience and radiation exposure using primary outcome measures (radiation dose and total screening time/fluoroscopy time). To be included in the review, the study population had to compare varying surgeon experience levels and their effect on the primary outcomes. A total of eighteen studies were included in the review. The studies were a mix of prospective and retrospective studies with low to moderate quality as evaluated by the MINORs criteria. Studies were variable in defining surgeon experience levels and in the type of operations being performed. Majority of the studies showed that inexperienced surgeons/trainees had a higher total fluoroscopy time and a higher mean radiation exposure as compared to experienced surgeons. We conclude that higher surgeon experience significantly reduces usage of fluoroscopy and the consequent radiation exposure in orthopedic procedures. Introduction of strict radiation guidelines involving limited usage of fluoroscopy and supervision of trainees may be beneficial in controlling radiation exposure in the future.
随着全球手术室中术中透视的使用日益增加,辐射暴露问题已成为医院工作人员、医生和患者共同关注的主要问题。由于透视已成为骨科术中管理不可或缺的一部分,我们试图确定外科医生的级别或经验是否会对辐射使用量及由此产生的暴露量产生影响。我们进行了一项系统综述,使用主要结局指标(辐射剂量和总筛查时间/透视时间)来研究外科医生经验与辐射暴露之间的关联。要纳入该综述,研究人群必须比较不同的外科医生经验水平及其对主要结局的影响。该综述共纳入了18项研究。这些研究包括前瞻性和回顾性研究,根据MINORs标准评估,质量为低到中等。研究在定义外科医生经验水平和所进行的手术类型方面存在差异。大多数研究表明,与经验丰富的外科医生相比,经验不足的外科医生/实习生的总透视时间更长,平均辐射暴露更高。我们得出结论,外科医生经验越丰富,在骨科手术中显著减少透视的使用及随之而来的辐射暴露。引入涉及限制透视使用和对实习生进行监督的严格辐射指南,可能有利于未来控制辐射暴露。
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