Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Clin Spine Surg. 2023 Apr 1;36(3):90-95. doi: 10.1097/BSD.0000000000001450. Epub 2023 Feb 28.
Prospective cohort study.
C-arm fluoroscopy and O-arm navigation are vital tools in modern spine surgeries, but their repeated usage can endanger spine surgeons. Although a surgeon's chest and abdomen are protected by lead aprons, the eyes and extremities generally receive less protection.
In this study, we compare differences in intraoperative radiation exposure across the protected and unprotected regions of a surgeon's body.
Sixty-five consecutive spine surgeries were performed by a single spine-focused neurosurgeon over 9 months. Radiation exposure to the primary surgeon was measured through dosimeters worn over the lead apron, under the lead apron, on surgical loupes, and as a ring on the dominant hand. Differences were assessed with rigorous statistical testing and radiation exposure per surgical case was extrapolated.
During the study, the measured radiation exposure over the apron, 176 mrem, was significantly greater than that under the apron, 8 mrem (P = 0.0020), demonstrating a shielding protective effect. The surgeon's dominant hand was exposed to 329 mrem whereas the eyes were exposed to 152.5 mrem of radiation. Compared with the surgeon's protected abdominal area, the hands (P = 0.0002) and eyes (P = 0.0002) received significantly greater exposure. Calculated exposure per case was 2.8 mrem for the eyes and 5.1 mrem for the hands. It was determined that a spine-focused neurosurgeon operating 400 cases annually will incur a radiation exposure of 60,750 mrem to the hands and 33,900 mrem to the eyes over a 30-year career.
Our study found that spine surgeons encounter significantly more radiation exposure to the eyes and the extremities compared with protected body regions. Lifetime exposure exceeds the annual limits set by the International Commission on Radiologic Protection for the extremities (50,000 mrem/y) and the eyes (15,000 mrem/y), calling for increased awareness about the dangerous levels of radiation exposure that a spine surgeon incurs over one's career.
前瞻性队列研究。
C 臂透视和 O 臂导航是现代脊柱手术中的重要工具，但它们的重复使用会危及脊柱外科医生的健康。尽管外科医生的胸部和腹部都有铅围裙保护，但眼睛和四肢通常受到的保护较少。
本研究旨在比较外科医生身体受保护和未受保护区域的术中辐射暴露差异。
在 9 个月内，由一名专注于脊柱的神经外科医生进行了 65 例连续脊柱手术。通过戴在铅围裙上、铅围裙下、手术放大镜上以及戴在优势手上的剂量计来测量主刀医生的辐射暴露。通过严格的统计检验评估差异，并推断每个手术的辐射暴露量。
在研究期间，围裙上测量到的辐射暴露量为 176 毫雷姆，明显高于围裙下的 8 毫雷姆（P=0.0020），表明具有屏蔽保护作用。外科医生的优势手受到 329 毫雷姆的辐射暴露，而眼睛受到 152.5 毫雷姆的辐射暴露。与外科医生受保护的腹部区域相比，手部（P=0.0002）和眼睛（P=0.0002）受到的辐射暴露明显更大。按例计算，眼睛的暴露量为 2.8 毫雷姆，手部为 5.1 毫雷姆。确定一名每年进行 400 例手术的专注于脊柱的神经外科医生，在 30 年的职业生涯中，手部将受到 60750 毫雷姆的辐射暴露，眼部将受到 33900 毫雷姆的辐射暴露。
我们的研究发现，与受保护的身体区域相比，脊柱外科医生的眼睛和四肢受到的辐射暴露明显更多。一生中的辐射暴露量超过了国际放射防护委员会为四肢（50000 毫雷姆/年）和眼睛（15000 毫雷姆/年）设定的年度限制，这呼吁人们提高对脊柱外科医生在职业生涯中所承受的危险辐射暴露水平的认识。
