Tamaki Yasuaki, Yamashita Kazuta, Nakajima Daiki, Omichi Yasuyuki, Takahashi Yoshinori, Takai Michihiro, Tamaki Shunsuke, Goto Tomohiro, Hayashi Hiroaki, Higashino Kosaku, Tsuruo Yoshihiro, Sairyo Koichi
Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.
Department of Orthopedics, Tokushima Municipal Hospital, 2-34 Kitajosanjima, Tokushima, 770-0812, Japan.
J Occup Med Toxicol. 2023 Nov 30;18(1):27. doi: 10.1186/s12995-023-00396-0.
Fluoroscopy is indispensable when determining appropriate and effective interventions in orthopedic surgery. On the other hand, there is growing concern about the health hazards of occupational radiation exposure. The aim of this cadaveric simulation study was to measure radiation exposure doses to the surgical team during hip surgery.
We reproduced the intraoperative setting of hip surgery using 7 fresh frozen cadavers (5 male, 2 female) to simulate patients and mannequins to simulate the surgeon, scrub nurse, and anesthesiologist. Six real-time dosimeters were mounted at sites corresponding to the optic lens, thyroid gland, chest, gonads, foot, and hand on each mannequin. The radiation exposure dose to each team member was measured during posteroanterior and lateral fluoroscopic imaging.
Radiation exposure doses to the surgeon were significantly higher during 3 min of lateral imaging than during 3 min of posteroanterior imaging at the optic lens (8.1 times higher), thyroid gland (10.3 times), chest (10.8 times), and hand (19.8 times) (p = 0.018, p = 0.018, p = 0.018, and p = 0.018, respectively). During lateral imaging, the radiation doses to the nurse were 0.16, 0.12, 0.09, 0.72, and 0.38 times those to the surgeon at the optic lens, thyroid, chest, gonads, and foot, respectively. The radiation dose to the anesthesiologist was zero at all anatomic sites during posteroanterior imaging and very small during lateral imaging.
Radiation exposure dose was significantly higher during lateral imaging up to 19.8 times comparing to the posteroanterior imaging. It is effective to reduce the lateral imaging time for reducing the intraoperative radiation exposure. In addition, appropriate distance from fluoroscopy resulted in very low exposure for nurses and anesthesiologists. Surgeon should pay attention that surgical staff do not get closer than necessary to the irradiation field.
在骨科手术中确定适当且有效的干预措施时，荧光透视检查必不可少。另一方面，人们越来越关注职业辐射暴露对健康的危害。本尸体模拟研究的目的是测量髋关节手术期间手术团队的辐射暴露剂量。
我们使用7具新鲜冷冻尸体（5男2女）模拟患者，使用人体模型模拟外科医生、洗手护士和麻醉医生，再现了髋关节手术的术中场景。在每个人体模型上，将6个实时剂量计安装在对应于眼镜片、甲状腺、胸部、性腺、足部和手部的部位。在前后位和侧位荧光透视成像期间，测量每个团队成员的辐射暴露剂量。
在侧位成像的3分钟内，外科医生在眼镜片（高8.1倍）、甲状腺（10.3倍）、胸部（10.8倍）和手部（19.8倍）处的辐射暴露剂量显著高于前后位成像的3分钟（分别为p = 0.018、p = 0.018、p = 0.018和p = 0.018）。在侧位成像期间，护士在眼镜片、甲状腺、胸部、性腺和足部的辐射剂量分别为外科医生的0.16、0.12、0.09、0.72和0.38倍。在前后位成像期间，麻醉医生在所有解剖部位的辐射剂量均为零，在侧位成像期间非常小。
与前后位成像相比，侧位成像期间的辐射暴露剂量显著更高，高达19.8倍。减少侧位成像时间对于减少术中辐射暴露是有效的。此外，与荧光透视保持适当距离可使护士和麻醉医生的暴露非常低。外科医生应注意确保手术人员不要比必要距离更靠近照射区域。
