Fluoroscopic Radiation Exposure in Spinal Surgery: In Vivo Evaluation for Operating Room Personnel.

Abstract

Prospective in vivo investigation of fluoroscopic radiation exposure during spinal surgery. To quantify the total amount of radiation dosage and identify techniques to maintain safe levels of fluoroscopic exposure in the operating room. No previous study has performed an in vivo examination of fluoroscopic radiation exposure to the spinal surgeon and operating room personnel. Previous similar studies were in vitro, used older versions of fluoroscopy, and increased fluoro times associated with pedicle screw placement. Thirty-five surgeries were evaluated in 18 males and 17 females (mean age 52.4 y; range, 26.0-79.4). Surgeries included 37 lumbar levels fused, 45 lumbar decompressions, 8 anterior cervical fusions, and 19 transforaminal lumbar interbody fusion procedures. Spinal instrumentation was implemented in all fusion procedures (104 lumbar pedicle screws, 14 iliac, 22 anterior cervical). Radiation dosimetry was obtained through unprotected badges placed on surgeon's chest, first assistant chest, cranial and caudal end of operating table. Total fluoroscopic time was 37.01 minutes. Mean fluoroscopic time with lumbar spine instrumentation was greater than decompression alone (1.74 vs. 0.22 min). Total fluoroscopic radiation exposure was obtained for surgeon (1225 mrem), first assistant (369 mrem), cranial table (92 mrem), and caudal table (150 mrem). Mean dose/min (mrem/min) was calculated for surgeon (33.1), first assistant (9.97), cranial table (2.48), and caudal table (4.05). To remain below the maximum yearly permissible level of radiation, the estimated total number of minutes for the surgeon would be 453. The results of this in vivo study indicate fluoroscopic dosage to the spine surgeon remains below the annual maximum limit of radiation exposure. Increasing distance from radiation source led to a significantly diminished in vivo dosimetry reading. Monitoring fluoroscopic time and maintaining a distance from the beam source, radiation exposure to the spine surgeon may be kept within current safety standards.