Department of Orthopaedic Surgery and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina.
Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California.
J Bone Joint Surg Am. 2021 Sep 1;103(17):1646-1651. doi: 10.2106/JBJS.20.02024.
Standard lead aprons and vests do not adequately shield the most common breast cancer site, the upper outer quadrant (UOQ), from intraoperative radiation. The purpose of the present study was to determine if lead sleeves, wings, and/or axillary supplements decreased intraoperative radiation exposure of the UOQ of the breast.
An anthropomorphic torso phantom (simulating the female surgeon) was placed adjacent to a standard operating room table. Dosimeters were placed bilaterally over the UOQ of the breast. Scatter radiation dose equivalent rates (mrem/hr) were measured during continuous fluoroscopy of a pelvic phantom (simulating the patient). Five protection configurations (no lead; lead vest; and vest with sleeves, wings, and axillary supplements), 2 surgeon positions (facing the table and perpendicular to the table), and 2 C-arm positions (anteroposterior and cross-table lateral projection) were tested. The t test was utilized with a Bonferroni correction for multiple t tests.
Lead sleeves and axillary supplements decreased intraoperative radiation exposure to the UOQ of the breast when compared with a well-fitted standard lead vest alone (p < 0.01) across all surgeon and C-arm positions. The addition of wings decreased radiation exposure to a lesser extent than sleeves or axillary supplements, and the difference when compared with the lead vest alone did not reach significance (p = 0.29). Breast radiation exposure in the C-arm cross-table lateral projection was highest across all testing.
The UOQ of the breast is not adequately protected by standard lead vests alone or vests with the addition of wings. Axillary supplements and sleeves improved protection of the breast.
Modifications of lead protective vests may improve intraoperative breast radiation protection.
标准的铅围裙和背心不能充分保护最常见的乳腺癌部位，即上部外象限（UOQ）免受术中辐射。本研究的目的是确定铅袖套、翼片和/或腋窝补充物是否可以减少乳腺癌上部外象限的术中辐射暴露。
将模拟女性外科医生的人体躯干模型放置在标准手术台旁边。在对模拟患者的骨盆模型进行连续透视时，在乳房的UOQ 双侧放置剂量计。测量散射辐射剂量当量率（mrem/hr）。测试了 5 种保护配置（无铅；铅背心；带有袖套、翼片和腋窝补充物的背心）、2 种外科医生位置（面向桌子和垂直于桌子）和 2 种 C 臂位置（前后位和跨桌侧位）。使用 Bonferroni 校正多重 t 检验对 t 检验进行了校正。
与单独使用合身的标准铅背心相比，铅袖套和腋窝补充物降低了对乳房上部外象限的术中辐射暴露（p <0.01），无论外科医生和 C 臂位置如何。翼片的添加减少了辐射暴露的程度小于袖套或腋窝补充物，与单独使用铅背心相比，差异没有达到显著水平（p = 0.29）。在所有测试中，C 臂跨桌侧位的乳房辐射暴露最高。
标准铅背心单独或加用翼片不能充分保护乳房的上部外象限。腋窝补充物和袖套改善了乳房的保护。
铅防护背心的修改可能会改善术中乳房辐射防护。
