The most restrictive limit is to the lens of the eye, where an annual limit of 50 mSv, or 100 mSv within 5 years, has been introduced into the International Atomic Energy Agency (IAEA) Basic Safety Standards (BSS). According to legal regulations, the limit for dose equivalent to the skin and extremities is 500 mSv per year. This issue seems especially relevant for spine surgeons: Compared to other procedures involving fluoroscopy, radiation exposure of the surgeon is up to 12 times greater during spine surgery 6.įindings on these considerable health risks led to a steady reduction of the annual occupational threshold recommendation by the International Commission on Radiological Protection (ICRP) to an effective dose of 20 mSv averaged over 5 years with no single year having more than 50 mSv exposure 7. Less life-threatening, but also health relevant for long time exposure to radiation amongst medical workers, is the dose-dependent induction of cataract in human eyes’ lens tissue 4, 5. This issue seems even more alarming in the context of a 600% increase of medical radiation that has been reported for the US population since the 1980s, mainly resulting from diagnostic procedures 3. Furthermore, in a small Italian hospital, where radiation protection practice was poor, a retrospective study revealed a cancer incidence of 29% (9 in 31) in orthopaedic surgeons exposed to medical radiation compared to 4% (7 in 158) in unexposed orthopaedic surgeons 2. Recent reports on 13% increase of cancer risk amongst members of the Scoliosis Research Society 1 aroused worries amongst medical workers in the field of spinal surgery, concerning their own and their patients’ health risk caused by radiographic imaging. Especially for a spinal surgeon, who is mainly exposed amongst OR personnel, radiation prevention and protection must remain a main issue. Although patient’s radiation dose is approximately 3-fold during navigation compared to the fluoroscopy, we found that a spinal surgeon could perform up to 10-fold number of surgeries (10.000 versus 883) until maximum permissible annual effective radiation dose would be reached. To our knowledge, these data present the first real life, detailed comparison of radiation exposure on OR personnel and patients between clinical use of navigation and fluoroscopy. There was a significant correlation between patient BMI and radiation exposure to the surgery field during fluoroscopy. The highest eye’s lens region value was measured during fluoroscopy for the patient (185 ± 165 µSv navigation: 205 ± 60 µSv p = 0.57) and the surgeon (164 ± 74 µSv navigation: 92 ± 41 µSv p < 0.001). ![]() When compared to the surgeon, other OR personnel had significantly lower radiation doses on all body regions using fluoroscopy, and similar dose during navigation. Amongst OR personnel exposure of the surgeon was significant higher during fluoroscopy (right hand: 566 ± 560 µSv and thoracic region: 275 ± 147 µSv followed by thyroid and forehead) compared to navigation (right finger: 49 ± 19 µSv similar levels for all regions p < 0.001 in all regions). The highest patients values were measured in the surgery field and gonads area during navigation (43.2 ± 19.4 mSv fluoroscopy: 27.7 ± 31.3 mSv p = 0.02), followed by the thoracic region during fluoroscopy (7.7 ± 14.8 mSv navigation: 1.1 ± 1.0 mSv p = 0.06), other measured regions can be considered marginal in comparison. Comparison between patient characteristics and radiation exposure was included. Radiation exposure was measured on several body regions with thermoluminescent dosimeters on patient and OR personnel (surgeon, assistant, sterile nurse, radiology technologist). Lumbosacral dorsal spinal fusion was performed in 37 patients (19 navigated, 18 fluoroscopy) during this prospective study. To particularize a cumulative risk estimation of radiation of personnel and patient, depending on used methods (C-arm fluoroscopy, O-arm navigation) and patient characteristics during spinal surgery, detailed investigation of radiation exposure in a clinical setting is required. Hazards caused by ionizing radiation raised concern on personnel’s work life long exposure in the operating room (OR). Intraoperative radiography imaging is essential for accurate spinal implant placement.
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