Abstract
ABSTRACT Objective To estimate the amount of radiation received and accumulated in the bodies of two surgeons, one being the responsible surgeon and the other the assistant, performing spine surgery procedures over a period of 25 years. Methods Seventy-two spinal surgeries were performed during a seven-month period and the radiation loads were measured in both surgeons. The measurement of radiation was captured in fluoroscopy in anteroposterior and lateral incidences. The surgeon and the assistant used two dosimeters, one in the cervical region protecting the thyroid and the other on the lead apron in the genital region. The radioactive loads were measured in millisieverts and the accumulated charges were recorded monthly in both regions of the body in the two surgeons for seven months and the means for the work periods (1, 5, 10, 15, 20 and 25 years) were estimated. Results It was observed that in the surgeon the average accumulated radiation loads were 131.9% and 176.92% higher than those of the assistant in the cervical and genital regions, respectively. Conclusion While the use of X-rays is indispensable in routine orthopedic surgery, we have to consider the development of techniques of protection, rigor and discipline in the use of safety materials for surgeons. Preventive exposure reduction measures such as using thyroid protection equipment and turning the head away from the patient during fluoroscopy, among others, should be mandatory to promote less radiation exposure. Level of evidence II; Comparative prospective study.
Highlights
Fluoroscopy is an X-ray imaging technique widely used in orthopedics to obtain real-time images of the skeletal structures to confirm the reduction of fractures and guide the placement of implants during surgical procedures.[1,2,3] Intraoperative fluoroscopic images are extremely important in diagnosis and aid in the treatment of orthopedic pathologies
Seventy-two spinal surgeries were performed during a seven-month period and the radiation loads were measured in both surgeons
It is estimated that 50% of the surgeries performed by the surgeons lasted less than 3.86 hours and 50% of the surgeries lasted more than 3.86 hours
Summary
Fluoroscopy is an X-ray imaging technique widely used in orthopedics to obtain real-time images of the skeletal structures to confirm the reduction of fractures and guide the placement of implants during surgical procedures.[1,2,3] Intraoperative fluoroscopic images are extremely important in diagnosis and aid in the treatment of orthopedic pathologies. Spine surgery in particular is highly dependent on fluoroscopy for locating vertebral levels, guiding pedicle screw placement and evaluating instrumentation in reconstruction procedures.[4,5,6,7,8]. The use of fluoroscopy in spine surgeries, in which higher doses of radiation are used to achieve a suitable image compared to those used in other parts of the body, has increased markedly in recent years. One study[8] concluded that doses of radiation during spine surgery procedures are ten to twelve times higher than during non-spinal procedures. The organs sensitive to radiation include gonads, bone marrow, breasts, corneas, the gastrointestinal tract, lungs and thyroid glands,[12] and the concern of surgeons over the effects of exposure during radiation, mainly on such sensitive organs.[3,5,13,14,15,16] There is no dose of radiation, known to be safe but low doses of radiation during fluoroscopy in surgeries can accumulate over the life of the surgeon and warrant attention.[17,18,19]
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