Groover Michael T, Hinkley Jacob R, Gerow Daniel E, Bamberger H Brent, Evans Jennifer, Gazaille Roland E
Grandview Medical Center, Dayton, OH (Dr. Groover, Dr. Bamberger, Dr. Evans, and Dr. Gazaille); the Genesys Regional Medical Center, Grand Blanc, MI (Dr. Hinkley); and the Marian University College of Osteopathic Medicine, Indianapolis, IN (Dr. Gerow).
J Am Acad Orthop Surg Glob Res Rev. 2019 Jun 5;3(6):e089. doi: 10.5435/JAAOSGlobal-D-18-00089. eCollection 2019 Jun.
To our knowledge, no studies have studied the effect of metal instrumentation (MI) in the field of fluoroscopy regarding changes in the intensity, direction of scatter, and degree of radiation exposure to the patient and surgical team. The goal of this study was to determine whether the presence of MI increases scatter radiation exposure to the patient and surgical team when using a mini C-arm in the horizontal and vertical positions.
Four trials were conducted using a lamb limb specimen and a mini C-arm to simulate a forearm/wrist fracture fixation scenario. Radiation scatter percentages were measured with the mini C-arm in a vertical and horizontal position with and without the presence of MI (a six-hole 3.5-mm limited-contact dynamic compression plate attached to the specimen with six cortical screws and a self-retaining retractor) using a parallel plate radiation detector.
The patient, scrub technician, circulating nurse, and anesthesiologist were exposed to no detectable radiation. In the horizontal position with the presence of MI, there was a 181-fold increase in scatter radiation exposure to the first assistant's eyes (0.016% versus 2.893%, 1.4 × 10 Sv/min versus 3.5 × 10 Sv/min) and increased exposure to the surgeon's hands compared with the horizontal position with no MI. In the vertical position, the scatter radiation received by the first assistant's eyes increased (zero versus 2.9 × 10 Sv/min) with MI present, whereas the only radiation measured for the surgeon was in the right hand which did not change with MI present (2.2 × 10 Sv/min).
MI in the field of fluoroscopy increases scatter radiation exposure to a degree that may place the first assistant's yearly eye exposure in excess of the International Commission on Radiological Protection limit. Surgeons and their assistants should wear lead aprons, thyroid shields, and leaded glasses and minimize the usage of fluoroscopy with MI in the field.
据我们所知，尚无研究探讨金属器械（MI）在荧光透视领域对患者和手术团队的辐射强度、散射方向及辐射暴露程度变化的影响。本研究的目的是确定在水平和垂直位置使用小型C形臂时，MI的存在是否会增加患者和手术团队的散射辐射暴露。
进行了四项试验，使用羊肢标本和小型C形臂模拟前臂/腕部骨折固定场景。使用平行板辐射探测器，在有和没有MI（一块六孔3.5毫米有限接触动力加压钢板，用六枚皮质骨螺钉固定在标本上，以及一个自持牵开器）的情况下，在垂直和水平位置用小型C形臂测量辐射散射百分比。
患者、刷手技术员、巡回护士和麻醉医生未检测到辐射暴露。在有MI的水平位置，与没有MI的水平位置相比，第一助手眼睛的散射辐射暴露增加了181倍（0.016%对2.893%，1.4×10 Sv/分钟对3.5×10 Sv/分钟），外科医生手部的暴露也增加。在垂直位置，有MI时第一助手眼睛接收到的散射辐射增加（从无到2.9×10 Sv/分钟），而外科医生唯一测量到辐射的是右手，有MI时没有变化（2.2×10 Sv/分钟）。
荧光透视领域的MI会增加散射辐射暴露，其程度可能使第一助手的年度眼部暴露超过国际放射防护委员会的限值。外科医生及其助手应穿戴铅围裙、甲状腺防护装置和铅眼镜，并尽量减少荧光透视在该领域与MI的使用。
