Nguyen Don, Piché Frédérique, Mares Christopher, Denis Isabelle
Physical Medicine and Rehabilitation, Faculty of Medicine, Université de Montréal, Québec, Canada.
Radiation Safety Department, Centre Hospitalier de l'Université de Montréal, Québec, Canada.
Interv Pain Med. 2023 Aug 9;2(3):100273. doi: 10.1016/j.inpm.2023.100273. eCollection 2023 Sep.
Fluoroscopy is the recommended image guidance modality for most spinal pain interventions. However, it exposes interventional pain physicians to chronic ionizing radiation, with known risks to the eye, skin, and hand. The use of protective glasses and gloves is variable among pain physicians.
To document the total radiation exposure (mSv) by pain physicians to their eyes, hands and chest in an academic setting including various spinal interventions.
Four pain physicians wore a finger, head/collar (equivalent to eye exposure) and chest dosimeter over and under their lead apron during a three-month period where they performed their usual fluoroscopy-guided interventions, including close supervision of trainees. We calculated an average exposure per intervention and extrapolated the recorded exposure to a maximum, worst-case scenario of a caseload of 13 procedures per day, 5 days a week and 52 weeks per year.
Four pain physicians of variable experience performed 15 different types of procedures on 607 patients throughout the study period. The yearly maximum exposure scenarios for each pain physician were all below the Canadian Nuclear Safety Commission thresholds for nuclear energy workers: for the hands (31.56 mSv, 25.67 mSv, 20.59 mSv, 21.51 mSv; threshold = 500 mSv), eyes (16.01 mSv, 18.64 mSv, 24.08 mSv, 18.68 mSv; threshold = 50 mSv) and chest over the lead apron (28.27 mSv, 46.91 mSv, 30.00 mSv, 40,03 mSv; whole body threshold = 50 mSv), with some doses even below general population thresholds. The exposure under the lead apron was 0 mSv for each pain physician.
The standard practice of an interventional pain physician using fluoroscopy in this academic setting is below radiation exposure regulations, even in a theoretical, worst-case, maximum exposure scenario. Standard radiation protection practices such as the use of lead aprons and thyroid shields should still be used. However, this data is reassuring for pain physicians with a practice in fluoroscopy-guided interventions who wish to not use protective glasses or gloves.
荧光透视检查是大多数脊柱疼痛干预推荐使用的图像引导方式。然而，它会使介入疼痛科医生暴露于慢性电离辐射中，已知会对眼睛、皮肤和手部造成风险。疼痛科医生使用防护眼镜和手套的情况各不相同。
记录在学术环境中，包括各种脊柱干预措施下，疼痛科医生眼睛、手部和胸部的总辐射暴露量（毫希沃特）。
在为期三个月的时间里，四名疼痛科医生在穿着铅围裙的情况下，在铅围裙上方和下方佩戴手指、头部/项圈（相当于眼睛暴露）和胸部剂量仪，期间他们进行常规的荧光透视引导干预，包括对实习生的密切监督。我们计算了每次干预的平均暴露量，并将记录的暴露量推算到一个最大、最坏情况的假设中，即每天进行13例手术、每周工作5天、每年工作52周的工作量。
在整个研究期间，四名经验各异的疼痛科医生对607名患者进行了15种不同类型的手术。每位疼痛科医生每年的最大暴露量情况均低于加拿大核安全委员会对核能工作者设定的阈值：手部（31.56毫希沃特、25.67毫希沃特、20.59毫希沃特、21.51毫希沃特；阈值 = 500毫希沃特）、眼睛（16.01毫希沃特、18.64毫希沃特、24.08毫希沃特、18.68毫希沃特；阈值 = 50毫希沃特）以及铅围裙上方的胸部（28.27毫希沃特、46.91毫希沃特、30.00毫希沃特、40.03毫希沃特；全身阈值 = 50毫希沃特），有些剂量甚至低于普通人群的阈值。每位疼痛科医生在铅围裙下方的暴露量为0毫希沃特。
在这个学术环境中，介入疼痛科医生使用荧光透视检查的标准操作低于辐射暴露规定，即使在理论上最坏情况的最大暴露场景下也是如此。仍应采用标准的辐射防护措施，如使用铅围裙和甲状腺防护装置。然而，对于希望不使用防护眼镜或手套的从事荧光透视引导干预工作的疼痛科医生来说，这些数据令人安心。
