Birmingham Spinal Unit, Royal Orthopaedic Hospital, Birmingham, UK.
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Bone Joint J. 2021 Apr;103-B(4):1-7. doi: 10.1302/0301-620X.103B.BJJ-2020-1416.R3. Epub 2021 Feb 17.
To benchmark the radiation dose to patients during the course of treatment for a spinal deformity.
Our radiation dose database identified 25,745 exposures of 6,017 children (under 18 years of age) and adults treated for a spinal deformity between 1 January 2008 and 31 December 2016. Patients were divided into surgical (974 patients) and non-surgical (5,043 patients) cohorts. We documented the number and doses of ionizing radiation imaging events (radiographs, CT scans, or intraoperative fluoroscopy) for each patient. All the doses for plain radiographs, CT scans, and intraoperative fluoroscopy were combined into a single effective dose by a medical physicist (milliSivert (mSv)).
There were more ionizing radiation-based imaging events and higher radiation dose exposures in the surgical group than in the non-surgical group (p < 0.001). The difference in effective dose for children between the surgical and non-surgical groups was statistically significant, the surgical group being significantly higher (p < 0.001). This led to a higher estimated risk of cancer induction for the surgical group (1:222 surgical vs 1:1,418 non-surgical). However, the dose difference for adults was not statistically different between the surgical and non-surgical groups. In all cases the effective dose received by all cohorts was significantly higher than that from exposure to natural background radiation.
The treatment of spinal deformity is radiation-heavy. The dose exposure is several times higher when surgical treatment is undertaken. Clinicians should be aware of this and review their practices in order to reduce the radiation dose where possible. Cite this article: 2021;103-B(4):1-7.
为脊柱畸形患者的治疗过程中的患者辐射剂量进行基准测试。
我们的辐射剂量数据库确定了 2008 年 1 月 1 日至 2016 年 12 月 31 日期间接受脊柱畸形治疗的 6017 名儿童（<18 岁）和成人的 25745 次照射。患者分为手术（974 例）和非手术（5043 例）两组。我们记录了每位患者的电离辐射成像事件（射线照相，CT 扫描或术中透视）的次数和剂量。医学物理学家将所有普通射线照相，CT 扫描和术中透视的剂量组合成一个有效剂量（毫西弗特（mSv））。
手术组比非手术组有更多的基于电离辐射的成像事件和更高的辐射剂量暴露（p <0.001）。手术组和非手术组儿童的有效剂量差异具有统计学意义，手术组明显更高（p <0.001）。这导致手术组癌症诱导的风险估计更高（1：222 例手术与 1：1418 例非手术）。但是，手术组和非手术组之间成人的剂量差异无统计学意义。在所有情况下，所有队列接受的有效剂量均明显高于暴露于自然背景辐射的剂量。
脊柱畸形的治疗需要大量辐射。手术治疗时的剂量暴露要高出数倍。临床医生应意识到这一点，并审查其做法，以尽可能降低辐射剂量。
2021;103-B（4）：1-7.
