scholarly journals How Safe is “Safe”? Radiation Exposure From Intraoperative CT in Traditionally Safe Operating Room Zones

2019 ◽  
Author(s):  
Amy Ford ◽  
Bartosz Wojewnik
Keyword(s):  
Radiation Exposure ◽  
Operating Room ◽  
Intraoperative Ct ◽  
Safe Operating

Patient and Surgeon Radiation Exposure during Spinal Instrumentation Using Intraoperative CT-Based Navigation

2015 ◽  
Vol 15 (10) ◽  
pp. S169 ◽  
Author(s):  
Daniel Mendelsohn ◽  
Jason Strelzow ◽  
Nicolas Dea ◽  
Juliet N. Batke ◽  
Charles G. Fisher ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Spinal Instrumentation ◽  
Intraoperative Ct

Preoperative Localization of Spinal and Peripheral Pathologies for Surgery by Computed Tomography–Guided Placement of a Specialized Needle System

Neurosurgery ◽  
2010 ◽  
Vol 66 (4) ◽  
pp. 784-787 ◽  
Author(s):  
Philipp Slotty ◽  
Patrick Kröpil ◽  
Mark Klingenhöfer ◽  
Hans-Jakob Steiger ◽  
Daniel Hänggi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Peripheral Nerve ◽  
Radiation Exposure ◽  
Operating Room ◽  
Operating Room Personnel ◽  
Peripheral Nerve Surgery ◽  
Preoperative Marking ◽  
Intraoperative Fluoroscopy ◽  
Nerve Surgery ◽  
Intraoperative Localization

Abstract OBJECTIVE Exact intraoperative localization of pathologies in spinal and peripheral nerve surgery is not easily achieved. In spinal surgery, intraoperative fluoroscopy is the common method for identification of the level affected. It seldom visualizes the pathology itself and is prone to error in identifying anatomic disorders and superimposing structures. In peripheral nerve surgery, intraoperative fluoroscopy is of little value. The present technical study was conducted to evaluate the feasibility of using a preoperative computed tomography–guided needle marking system, which was previously developed for use in gynecology. The goal was to reduce intraoperative localization error and radiation exposure to patients and operating room personnel. METHODS We used a flexible hooked-wire needle marking system, which has previously been used for preoperative marking of breast lesions, to localize and tag spinal and peripheral nerve pathologies. Marking was carried out under computed tomographic control before surgery. Seven illustrative cases were chosen for this report: 6 patients with disorders of the spine and 1 patient with a peripheral nerve schwannoma. RESULTS No adverse reactions, aside from minor discomfort, were observed in this study. In all cases, the needle could be used as a reliable guide for the surgical approach and led directly to the pathology. In no case was additional intraoperative fluoroscopy needed. The level of radiation exposure to the patient as a result of computed tomography–based marking was similar to or less than that encountered in conventional intraoperative x-ray localization. Radiation exposure to the operating room personnel was eliminated by this method. CONCLUSION Preoperative marking of spinal level or peripheral nerve pathologies with a flexible hooked-wire needle marking system is feasible and appears to be safe and useful for neurosurgical spinal and peripheral procedures.

scholarly journals A Novel Augmented-Reality-Based Surgical Navigation System for Spine Surgery in a Hybrid Operating Room: Design, Workflow, and Clinical Applications

2019 ◽  
Vol 18 (5) ◽  
pp. 496-502 ◽  
Author(s):  
Erik Edström ◽  
Gustav Burström ◽  
Rami Nachabe ◽  
Paul Gerdhem ◽  
Adrian Elmi Terander
Keyword(s):  
Augmented Reality ◽  
Radiation Exposure ◽  
Pedicle Screw ◽  
Operating Room ◽  
Wound Closure ◽  
Surgical Navigation ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Hybrid Operating Room ◽  
Pedicle Screw Placement

Abstract BACKGROUND Treatment of several spine disorders requires placement of pedicle screws. Detailed 3-dimensional (3D) anatomic information facilitates this process and improves accuracy. OBJECTIVE To present a workflow for a novel augmented-reality-based surgical navigation (ARSN) system installed in a hybrid operating room for anatomy visualization and instrument guidance during pedicle screw placement. METHODS The workflow includes surgical exposure, imaging, automatic creation of a 3D model, and pedicle screw path planning for instrument guidance during surgery as well as the actual screw placement, spinal fixation, and wound closure and intraoperative verification of the treatment results. Special focus was given to process integration and minimization of overhead time. Efforts were made to manage staff radiation exposure avoiding the need for lead aprons. Time was kept throughout the procedure and subdivided to reflect key steps. The navigation workflow was validated in a trial with 20 cases requiring pedicle screw placement (13/20 scoliosis). RESULTS Navigated interventions were performed with a median total time of 379 min per procedure (range 232-548 min for 4-24 implanted pedicle screws). The total procedure time was subdivided into surgical exposure (28%), cone beam computed tomography imaging and 3D segmentation (2%), software planning (6%), navigated surgery for screw placement (17%) and non-navigated instrumentation, wound closure, etc (47%). CONCLUSION Intraoperative imaging and preparation for surgical navigation totaled 8% of the surgical time. Consequently, ARSN can routinely be used to perform highly accurate surgery potentially decreasing the risk for complications and revision surgery while minimizing radiation exposure to the staff.

Radiation risk amongst orthopaedic surgeons – Do we know the risk?

2018 ◽  
Vol 29 (5) ◽  
pp. 115-121 ◽  
Author(s):  
Sushmith R Gowda ◽  
Chris J Mitchell ◽  
Sherif Abouel-Enin ◽  
Charlotte Lewis
Keyword(s):  
Radiation Exposure ◽  
Operating Room ◽  
Radiation Risk ◽  
Healthcare Personnel ◽  
Orthopaedic Surgeons ◽  
Increased Risk ◽  
Medullary Nailing ◽  
Specific Safety ◽  
Effects Of Radiation ◽  
Harmful Effects

Radiation risk amongst orthopaedic surgeons and theatre personnel is increasing with increased use of fluoroscopy imaging. Increased radiation risk has been shown to be associated with an increased risk of malignancies, ocular and thyroid disorders. Very high exposures have been reported in spinal surgery and during intra-medullary nailing. With an increase in modern and percutaneous methods, the use of intra-operative fluoroscopy has increased as well. The aim of this article was to review the available evidence of radiation risk amongst healthcare personnel. A systematic search was carried out in PubMED, CINAHL and Cochrane on intra-operative radiation in trauma and orthopaedic operating room. Inclusion criteria were clinical studies and systematic reviews reporting on radiation exposure, fluoroscopy time and references to specific safety guidelines. This article highlights the safety aspects of radiation protection and harmful effects of radiation during orthopaedic procedures. The responsibility to minimise radiation exposure in operating theatre lies with the team within the operating room.

Radiation exposure to the personnel in the operating room and in the pathology due to SLN detection with Tc-99m-nanocolloid in breast cancer patients

2000 ◽  
Vol 39 (05) ◽  
pp. 142-145 ◽  
Author(s):  
H. Ostertag ◽  
E. Peppert ◽  
N. Czech ◽  
W. U. Kampen ◽  
C. Muhle ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Exposure ◽  
Operating Room ◽  
Radiation Risk ◽  
Breast Cancer Patients ◽  
Team Members ◽  
Staff Members ◽  
Dose Rates ◽  
Peritumoral Injection ◽  
Work Up

Summary Aim of this study was to assess the radiation exposure for the personnel in the operating room and in the pathology laboratories caused by radioguided SLN localization in breast cancer. Methods: In 15 patients dose rates were measured at various distances from the breast and tumor specimens during operation and pathological work-up at 3-5 h after peritumoral injection of 30 MBq Tc-99m-nanocolloid. Results: The dose rates were 84.1 ± 46.4 μGy/h at 2.5 cm, 3.57 ± 2.14 μGy/h at 30 cm, 0.87 ± 0.51 μGy/h at 100 cm, and 0.40 ± 0.20 μGy/h at 150 cm in the operating room and 44.4 ± 27.8 μGy/h at 2.5 cm, and 1.66 ± 1.34 μGy/h at 30 cm in the pathology laboratories. From these data the radiation exposure was calculated for 250 operations per year assuming a mean exposure time of 30 min for the surgical team members and of 10 min for the pathology staff. Under these conditions the finger dose is 10.5 mGy for the surgeon, and 5.55 mGy for the pathologist. The wholebody doses are 0.45 mSv, 0.11 mSv, 0.05 mSv, and 0.21 mSv for the surgeon, the operating room nurse, the anesthetist, and the pathologist, respectively. Conclusion: Since the radiation risk to staff members is low, a classification of the personnel in the operating room and in the pathology laboratories as occupational radiation exposed workers is not necessary.

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