Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion

Y. Raja Rampersaud, Kevin Foley, Alfred C. Shen, Scott Williams, Milo Solomito

Research output: Contribution to journalArticle

327 Citations (Scopus)

Abstract

Study Design. In vitro study to determine occupational radiation exposure during lumbar fluoroscopy. Objectives. To assess radiation exposure to the spine surgeon during fluoroscopically assisted thoracolumbar pedicle screw placement. Summery of Background Data. Occupational radiation exposure during a variety of fluoroscopically assisted musculoskeletal procedures has been previously evaluated. No prior study has assessed fluoroscopy-related radiation exposure to the spine surgeon. Methods. Bilateral pedicle screw placement (T11-S1) was performed in six cadavers using lateral fluoroscopic imaging. Radiation dose rates to the surgeon's neck, torso, and dominant hand were measured with dosimeter badges and thermolucent dosimeter (TLD) rings. Radiation levels were also quantified at various distances from the dorsal lumbar surface using an ion chamber radiation survey meter. Results. The mean dose rate to the neck was 8.3 mrem/min. The dose rate to the torso was greatest when the surgeon was positioned ipsilateral to the beam source (53.3 mrem/min, compared with 2.2 mrem/min on the contralateral side). The average hand dose rate was 58.2 mrem/min. A significant increase in hand dose rate was associated with placement of screws ipsilateral to the beam source (P = 0.0005) and larger specimens (P = 0.0007). Radiation levels significantly decreased as distance from the beam source and dorsal body surface increased. The greatest levels of radiation were noted on the side where the primary radiograph beam entered the cadaver. Conclusion. Fluoroscopically assisted thoracolumbar pedicle screw placement exposes the spine surgeon to significantly greater radiation levels than other, nonspinal musculoskeletal procedures that involve the use of a fluoroscope. In fact, dose rates are up to 10-12 times greater. Spine surgeons performing fluoroscopically assisted thoracolumbar procedures should monitor their annual radiation exposure. Measures to reduce radiation exposure and surgeon awareness of high-exposure body and hand positions are certainly called for.

Original languageEnglish (US)
Pages (from-to)2637-2645
Number of pages9
JournalSpine
Volume25
Issue number20
DOIs
StatePublished - Oct 15 2000

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Spine
Radiation
Hand
Torso
Fluoroscopy
Occupational Exposure
Cadaver
Neck
Pedicle Screws
Surgeons
Radiation Exposure
Ions
Radiation Dosimeters

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. / Rampersaud, Y. Raja; Foley, Kevin; Shen, Alfred C.; Williams, Scott; Solomito, Milo.

In: Spine, Vol. 25, No. 20, 15.10.2000, p. 2637-2645.

Research output: Contribution to journalArticle

Rampersaud, Y. Raja ; Foley, Kevin ; Shen, Alfred C. ; Williams, Scott ; Solomito, Milo. / Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. In: Spine. 2000 ; Vol. 25, No. 20. pp. 2637-2645.
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abstract = "Study Design. In vitro study to determine occupational radiation exposure during lumbar fluoroscopy. Objectives. To assess radiation exposure to the spine surgeon during fluoroscopically assisted thoracolumbar pedicle screw placement. Summery of Background Data. Occupational radiation exposure during a variety of fluoroscopically assisted musculoskeletal procedures has been previously evaluated. No prior study has assessed fluoroscopy-related radiation exposure to the spine surgeon. Methods. Bilateral pedicle screw placement (T11-S1) was performed in six cadavers using lateral fluoroscopic imaging. Radiation dose rates to the surgeon's neck, torso, and dominant hand were measured with dosimeter badges and thermolucent dosimeter (TLD) rings. Radiation levels were also quantified at various distances from the dorsal lumbar surface using an ion chamber radiation survey meter. Results. The mean dose rate to the neck was 8.3 mrem/min. The dose rate to the torso was greatest when the surgeon was positioned ipsilateral to the beam source (53.3 mrem/min, compared with 2.2 mrem/min on the contralateral side). The average hand dose rate was 58.2 mrem/min. A significant increase in hand dose rate was associated with placement of screws ipsilateral to the beam source (P = 0.0005) and larger specimens (P = 0.0007). Radiation levels significantly decreased as distance from the beam source and dorsal body surface increased. The greatest levels of radiation were noted on the side where the primary radiograph beam entered the cadaver. Conclusion. Fluoroscopically assisted thoracolumbar pedicle screw placement exposes the spine surgeon to significantly greater radiation levels than other, nonspinal musculoskeletal procedures that involve the use of a fluoroscope. In fact, dose rates are up to 10-12 times greater. Spine surgeons performing fluoroscopically assisted thoracolumbar procedures should monitor their annual radiation exposure. Measures to reduce radiation exposure and surgeon awareness of high-exposure body and hand positions are certainly called for.",
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