Kohmaru Shinya, Saito Yuichi, Takata Takeshi, Morita Shizuka, Takeyama Ryo, Kanamoto Yasuyuki, Nishida Tomoki, Dejima Hitoshi, Yamauchi Yoshikane, Kobayashi Ikuo, Kawamura Masafumi, Sakao Yukinori
Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
Advanced Comprehensive Research Organization, Teikyo University, Tokyo, Japan.
J Cardiothorac Surg. 2024 Dec 19;19(1):645. doi: 10.1186/s13019-024-03182-z.
Several methods can be used to intraoperatively identify pulmonary lesion using radiation technology. However, little is known about patient radiation exposure during chest surgery. We aimed to measure patients' radiation exposure from cone-beam computed tomography (CBCT) used in a hybrid operating room.
This retrospective study included patients who underwent surgical treatment in a hybrid operating room between April 2019 and December 2023 at the Teikyo University Hospital. All data was obtained prospectively, but the study was approved by the IRB as a retrospective study because of repeated extensions of study period in order to collect more cases. Skin radiation exposure was measured using five wearable dosimeters per patient. The measurements were compared to cumulative Air Kerma. Furthermore, the radiation exposure dose on the surgical side, which cannot be measured, was estimated by computer simulation.
Among 182 patients who underwent surgery in a hybrid operating room, radiation exposure measurements were conducted on 67 patients. The patients' mean age was 60.7 years. The average number of CBCT scans was 2.1 (1-5) and the intraoperative identification rate was 100%, with no marking-related complications. Average patient's skin radiation dose was 3.69 ± 5.48 mGy per dosimeter, and cumulative Air Kerma was 25.4 ± 19.3 mGy. The highest radiation exposure was recorded in the 5th intercostal space whereas the lowest was measured in the supraclavicular or 11th intercostal spaces. Referring to phantom and computer simulation data, the 5th and 8th intercostal spaces were significantly more exposed to radiation at not only measurement side but also the surgical field, particularly when the number of CT scans was four.
We found that the patient's 5th to 8th intercostal space was the most radiation exposed area by intraoperative CBCT imaging because the CBCT movement was restricted by the patient's arm, anesthesia machine, and operating table during chest surgery. In future, it is strongly required to research for radiation protection in this area. Furthermore, performing no more than three scans intraoperatively may be preferable in order to protect patients from radiation exposure during CBCT guided thoracic surgery.
有几种方法可用于在手术中使用放射技术识别肺部病变。然而，对于胸部手术期间患者的辐射暴露情况知之甚少。我们旨在测量在杂交手术室中使用锥形束计算机断层扫描（CBCT）时患者的辐射暴露情况。
这项回顾性研究纳入了2019年4月至2023年12月在帝京大学医院杂交手术室接受手术治疗的患者。所有数据均为前瞻性获取，但由于研究周期多次延长以收集更多病例，该研究被机构审查委员会批准为回顾性研究。每位患者使用五个可穿戴剂量计测量皮肤辐射暴露。将测量结果与累积空气比释动能进行比较。此外，通过计算机模拟估计手术侧无法测量的辐射暴露剂量。
在182例在杂交手术室接受手术的患者中，对67例患者进行了辐射暴露测量。患者的平均年龄为60.7岁。CBCT扫描的平均次数为2.1次（1 - 5次），术中识别率为100%，无标记相关并发症。每个剂量计测量的患者平均皮肤辐射剂量为3.69±5.48 mGy，累积空气比释动能为25.4±19.3 mGy。辐射暴露最高记录在第5肋间间隙，而最低记录在锁骨上或第11肋间间隙。参考体模和计算机模拟数据，第5和第8肋间间隙在测量侧和手术区域均显著受到更多辐射，特别是当CT扫描次数为4次时。
我们发现，由于胸部手术期间CBCT的移动受到患者手臂、麻醉机和手术台的限制，患者的第5至第8肋间间隙是术中CBCT成像辐射暴露最严重的区域。未来，迫切需要对该区域的辐射防护进行研究。此外，为了在CBCT引导的胸外科手术中保护患者免受辐射暴露，术中进行不超过三次扫描可能更为可取。
