scholarly journals Radiation Exposure to the Hand of a Spinal Interventionalist during Fluoroscopically Guided Procedures

2017 ◽  
Vol 11 (1) ◽  
pp. 75-81 ◽  
Author(s):  
Kazuta Yamashita ◽  
Hisanori Ikuma ◽  
Takuya Tokashiki ◽  
Takashi Maehara ◽  
Akihiro Nagamachi ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Prospective Study ◽  
Radiation Exposure ◽  
Radiological Protection ◽  
Dominant Hand ◽  
Annual Dose ◽  
Lead Apron ◽  
Left Chest ◽  
Glass Dosimeter ◽  
The Right

<sec><title>Study Design</title><p>Prospective study.</p></sec><sec><title>Purpose</title><p>During fluoroscopically guided spinal procedure, the hands of spinal surgeons are placed close to the field of radiation and may be exposed to ionizing radiation. This study directly measured the radiation exposure to the hand of a spinal interventionalist during fluoroscopically guided procedures.</p></sec><sec><title>Overview of Literature</title><p>Fluoroscopically guided spinal procedures have been reported to be a cause for concern due to the radiation exposure to which their operators are exposed.</p></sec><sec><title>Methods</title><p>This prospective study evaluated the radiation exposure of the hand of one spinal interventionalist during 52 consecutive fluoroscopic spinal procedures over a 3-month period. The interventionalist wore three real-time dosimeters secured to the right forearm, under the lead apron over the chest, and outside the lead apron over the chest. Additionally, one radiophotoluminescence glass dosimeter was placed under the lead apron over the left chest and one ring radiophotoluminescence glass dosimeter was worn on the right thumb. The duration of exposure and radiation dose were measured for each procedure.</p></sec><sec><title>Results</title><p>The average radiation exposure dose per procedure was 14.9 µSv, 125.6 µSv, and 200.1 µSv, inside the lead apron over the chest, outside the lead apron over the chest, and on the right forearm, respectively. Over the 3-month period, the protected radiophotoluminescence glass dosimeter over the left chest recorded less than the minimum reportable dose, whereas the radiophotoluminescence glass ring dosimeter recorded 368 mSv for the thumb.</p></sec><sec><title>Conclusions</title><p>Our findings indicated that the cumulative radiation dose measured at the dominant hand may exceed the annual dose limit specified by the International Commission on Radiological Protection. Spinal interventionalists should take special care to limit the duration of fluoroscopy and radiation exposure.</p></sec>

Collimation Reduces Radiation Exposure to the Surgeon in Endoscopic Spine Surgery: A Prospective Study

2021 ◽  
Author(s):  
H. Yener Erken ◽  
Onur Yilmaz
Keyword(s):  
Radiation Dose ◽  
Gamma Radiation ◽  
Prospective Study ◽  
Radiation Exposure ◽  
Spine Surgery ◽  
Lead Apron ◽  
Endoscopic Spine Surgery ◽  
A Prospective Study ◽  
Operating Surgeon

Abstract Background and Study Aims There are no previous studies in the literature comparing the radiation dose to which surgeons are exposed while using a standard fluoroscopy versus collimation during transforaminal percutaneous endoscopic lumbar diskectomy (PELD). The aim of this study is to compare this and to evaluate the effectiveness of collimation in reducing radiation exposure. Methods In this study, the operating surgeon (single surgeon) placed a gamma radiation dosimeter on his chest outside of the lead apron during transforaminal PELD surgeries and measured the radiation exposure immediately after each surgery. As foraminoplasty using free-hand reamers is a longer procedure and requires more fluoroscopy shots, we divided the patients into two groups. The first group consisted of 24 patients (nonforaminoplasty group). The second group consisted of 13 patients (foraminoplasty group). We compared the radiation exposure to the operating surgeon using a standard fluoroscopy versus collimation for each group individually and overall. We randomized the patients within each group based on the order in which they had their respective procedures. Results We analyzed 39 patients who underwent transforaminal PELD between May and December 2019. In both groups, as well as overall, the recorded radiation exposure to the surgeon was significantly lower in surgeries in which collimation was used. In the first group, the radiation dose was 0.083 versus 0.039 mSv per surgery (p = 0.019), whereas in the second group, it was 0.153 versus 0.041 mSv per surgery (p = 0.001), and overall it was 0.108 versus 0.039 mSv per surgery (p < 0.001). Conclusion The use of collimation during transforaminal PELD significantly reduces spine the surgeon's exposure to radiation. Therefore, spine surgeons should consider using collimation during transforaminal PELD.

scholarly journals Radiation Dose Reduction during Radial Cardiac Catheterization: Evaluation of a Dedicated Radial Angiography Absorption Shielding Drape

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Andrew Ertel ◽  
Jeffrey Nadelson ◽  
Adhir R. Shroff ◽  
Ranya Sweis ◽  
Dean Ferrera ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Cardiac Catheterization ◽  
Patient Comfort ◽  
Bleeding Complications ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Radiation Scatter ◽  
The Right ◽  
The Impact

Objectives. Radiation scatter protection shield drapes have been designed with the goal of decreasing radiation dose to the operators during transfemoral catheterization. We sought to investigate the impact on operator radiation exposure of various shielding drapes specifically designed for the radial approach. Background. Radial access for cardiac catheterization has increased due to improved patient comfort and decreased bleeding complications. There are concerns for increased radiation exposure to patients and operators. Methods. Radiation doses to a simulated operator were measured with a RadCal Dosimeter in the cardiac catheterization laboratory. The mock patient was a 97.5 kg fission product phantom. Three lead-free drape designs were studied. The drapes were placed just proximal to the right wrist and extended medially to phantom’s trunk. Simulated diagnostic coronary angiography included 6 minutes of fluoroscopy time and 32 seconds of cineangiography time at 4 standard angulated views (8 s each), both 15 frames/s. ANOVA with Bonferroni correction was used for statistical analysis. Results. All drape designs led to substantial reductions in operator radiation exposure compared to control (P<0.0001). The greatest decrease in radiation exposure (72%) was with the L-shaped design. Conclusions. Dedicated radial shielding drapes decrease radiation exposure to the operator by up to 72% during simulated cardiac catheterization.

EVALUATION OF RADIATION DOSE IN DIFFERENT POSITIONS AROUND THE PATIENT TABLE DURING INTERVENTIONAL CARDIOLOGY PROJECTIONS

2019 ◽  
Vol 188 (2) ◽  
pp. 199-204
Author(s):  
Y Lahfi ◽  
A Ismail
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Dose Rate ◽  
Radiation Protection ◽  
Interventional Cardiology ◽  
X Ray ◽  
Dose Rates ◽  
Patient Table ◽  
The Right

Abstract The aim of the present study was to evaluate the radiation exposure around the patient table as relative to the cardiologist position dose value. The dose rates at eight points presuming staff positions were measured for PA, LAO 30° and RAO 30° radiographic projections, and then normalized to the cardiologist’s position dose-rate value. The results show that in PA and RAO 30° projections, the normalized dose rate was higher by 9–22% at the right side of the table at a distance of 50 cm, while it was higher up to 31% at the left side for the same measured points in the LAO 30°. The differences of normalized dose rates for the both table sides were lower and decreased at farther positions. The obtained results correspond to the recommendations of staff radiation protection in Cath-labs with regards to X-ray tube and detector positions.

scholarly journals Chernobyl-level radiation exposure damages bumblebee reproduction: a laboratory experiment

2020 ◽  
Vol 287 (1937) ◽  
pp. 20201638
Author(s):  
Katherine E. Raines ◽  
Penelope R. Whitehorn ◽  
David Copplestone ◽  
Matthew C. Tinsley
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Dose Rate ◽  
Colony Growth ◽  
High Dose ◽  
Radiological Protection ◽  
Negative Consequences ◽  
Exclusion Zone ◽  
Radiation Dose Rate ◽  
Dose Rates

The consequences for wildlife of living in radiologically contaminated environments are uncertain. Previous laboratory studies suggest insects are relatively radiation-resistant; however, some field studies from the Chernobyl Exclusion Zone report severe adverse effects at substantially lower radiation dose rates than expected. Here, we present the first laboratory investigation to study how environmentally relevant radiation exposure affects bumblebee life history, assessing the shape of the relationship between radiation exposure and fitness loss. Dose rates comparable to the Chernobyl Exclusion Zone (50–400 µGy h −1 ) impaired bumblebee reproduction and delayed colony growth but did not affect colony weight or longevity. Our best-fitting model for the effect of radiation dose rate on colony queen production had a strongly nonlinear concave relationship: exposure to only 100 µGy h −1 impaired reproduction by 30–45%, while further dose rate increases caused more modest additional reproductive impairment. Our data indicate that the practice of estimating effects of environmentally relevant low-dose rate exposure by extrapolating from high-dose rates may have considerably underestimated the effects of radiation. If our data can be generalized, they suggest insects suffer significant negative consequences at dose rates previously thought safe; we therefore advocate relevant revisions to the international framework for radiological protection of the environment.

Surgeon and patient radiation exposure in minimally invasive transforaminal lumbar interbody fusion

2008 ◽  
Vol 9 (6) ◽  
pp. 570-573 ◽  
Author(s):  
Rajesh K. Bindal ◽  
Sharon Glaze ◽  
Meghann Ognoskie ◽  
Van Tunner ◽  
Robert Malone ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Radiation Exposure ◽  
Interbody Fusion ◽  
Ring Finger ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Senior Author ◽  
Dominant Hand ◽  
Lumbar Interbody Fusion ◽  
Annual Dose ◽  
Thermoluminescent Dosimeter

Object Minimally invasive transforaminal lumbar interbody fusion (TLIF) is an increasingly popular procedure. The technique involves use of fluoroscopy to assist with pedicle screw (PS) placement. The potential exists for both the surgeon and the patient to become exposed to significant amounts of radiation. The authors undertook this study to quantify the radiation dose to the surgeon and patient during minimally invasive TLIF. Methods The authors undertook a prospective study of 24 consecutive patients who underwent minimally invasive TLIF. All surgeries were performed by the senior author (R.K.B.), who used techniques previously described. The surgeon wore a radiation monitor under an apron-style lead shield at waist level, at an unshielded collar location, and as a sterile ring badge containing a thermoluminescent dosimeter on the dominant (right) hand ring finger. Dosimeter readings were obtained for each case. A total of 33 spinal levels were treated in 24 patients. All treated levels were between L3–4 and L5–S1. In all cases of 1-level disease, 4 PSs were placed, and in all cases of 2-level disease, 6 screws were placed. Results . Mean fluoroscopy time was 1.69 minutes per case (range 3.73–0.82 minutes). Mean exposure per case to the surgeon on his dominant hand was 76 mRem, at the waist under a lead apron was 27 mRem, and at an unprotected thyroid level was 32 mRem. Mean exposure to the patient's skin was 59.5 mGy (range 8.3–252 mGy) in the posteroanterior plane and 78.8 mGy (range 6.3–269.5 mGy) in the lateral plane. Conclusions To the authors' knowledge, this is the first study of radiation exposure to the surgeon or patient in minimally invasive TLIF. Patient exposures were low and compare favorably with exposures involving other common interventional fluoroscopically guided procedures. Surgeon exposures are limited but require careful monitoring. Annual dose limits could be exceeded if a large number of these and other fluoroscopically guided procedures were performed.

Radiation exposure of radiologists during different types of CT-guided interventions: an evaluation using dosimeters placed above and under lead protection

2019 ◽  
Vol 61 (1) ◽  
pp. 110-116
Author(s):  
Fabian Henry Jürgen Elsholtz ◽  
Janis Lucas Vahldiek ◽  
Sebastian Wyschkon ◽  
Maximilian De Bucourt ◽  
Gerd Koletzko ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Eye Lens ◽  
Radiological Protection ◽  
Ct Guided ◽  
Right Hand ◽  
Experienced Radiologist ◽  
Different Types ◽  
Drain Placement ◽  
The Right ◽  
Periradicular Infiltration

Background Computed tomography (CT) is widely used not only for diagnostic purposes but also for image guidance during different types of interventions. Therefore, radiation exposure of both patients and interventional radiologists remains a much-discussed topic. Purpose To quantify radiation exposure of interventional radiologists during multiple CT-guided interventions using dosimeters placed under and outside standard protective lead clothing. Material and Methods A total of 113 consecutive interventions covering three different types of procedures (grouped as periradicular infiltration therapy, biopsies, and drain placement) and performed using routine clinical protocols were prospectively analyzed. The interventions were performed by two radiologists of different experience levels with identically placed dosimeters outside and underneath their protective clothing. Personal doses (right hand, eye lens, thyroid gland, thorax, gonads) were cumulatively measured for each type of intervention and separately for the two radiologists. Results Personal dose was below the detection limit of the dosimeters during periradicular infiltration therapy. In the biopsy and drain placement groups, the highest dose was found for the right hand (maximum cumulative dose = 1.84 ± 1.30 mSv in 19 consecutive drain placements). Under the protective gear, exposure was only observed for drain placements performed by the less experienced radiologist (maximum = 0.05 ± 0.04 mSv for the eye lens). Conclusion Personal doses measured here were far below annual thresholds published by the International Commission on Radiological Protection. Therefore, performing multiple CT-guided interventions appears to be safe for interventional radiologists in terms of radiation exposure.

scholarly journals Ionizing Radiation Dose Exposure to the Ocular Region of Pain Physicians During C-arm Guided Pain Interventions

2018 ◽  
Vol 1 (21;1) ◽  
pp. E523-E532
Author(s):  
Raymond Kelly
Keyword(s):  
Radiation Dose ◽  
Ionizing Radiation ◽  
Radiation Exposure ◽  
University Hospital ◽  
Whole Body ◽  
Pain Medicine ◽  
Annual Dose ◽  
Effective Radiation Dose ◽  
International Guidelines ◽  
Dose Area Product

Background: The growth of interventional pain medicine in recent years has resulted in more procedures being carried out under fluoroscopic guidance. The proximity of the pain physician (PP) to ionization radiation (IR) potentially increases the risk of radiation exposure to the ocular region. A European directive has reduced the limits of occupational ocular dose 7.5-fold. Objectives: The objectives of this study are to quantify the typical IR exposure in the ocular region of PP and to compare it to recommended international guidelines. Study Design: Three consultants involved in the pain unit service were enrolled in the study to reflect the dose implications involved with different caseloads, training obligations, and procedure types. All 3 consultants were experienced primary operators. Setting: The study was undertaken at the pain management suite in the South Infirmary Victoria University Hospital (SIVUH). Annually, this unit performs 2,800 fluoroscopic guide pain procedures. Methods: Thermoluminescent dosimeters (TLDs) calibrated to measure eye lens doses [Hp (0.07)] and whole-body doses (WBDs) were fitted to 3 pain consultants while they undertook imaging-guided pain procedures using mobile C-arm fluoroscopy over a 3-month period. The duration of radiation exposure, screening time (seconds), and procedure type were recorded. Radiation dose was calculated to estimate the effective radiation dose to the ocular region using (i) dose-area product (DAP) in milliGray per centimeter squared (mGycm2 ) and (ii) Air Kerma (AK) values in mGy. Results: IR doses were effectively recorded in 682 cases over 3 months and the data extrapolated. The estimated annual lens dose experienced by pain physicians performing fluoroscopy-guided procedures is less than the recommended international guidelines. A significant linear relationship between screening time and IR exposure was estimated (rs = 0.93, P < 0.01) Limitations: In many centers, including our own, fluoroscopy procedures are undertaken by nonconsultant staff. Therefore, a small single-center cohort recruiting experienced consultant staff and not including pain fellows or registrars/residents with varying levels of experience is a limitation. Conclusion: While IR to the ocular region was significantly less than the recommended European safety guidelines, the annual dose needs to be confirmed in pain physicians with a lesser degree of clinical experience. Key words: Ionizing radiation, ocular, radiation protection, pain medicine, interventional

EVALUATION OF THE RADIATION DOSE TO THE HANDS OF ORTHOPAEDIC SURGEONS DURING FLUOROSCOPY USING STORED IMAGES

2020 ◽  
Vol 189 (2) ◽  
pp. 157-162
Author(s):  
Carlo Giordano ◽  
Ivo Monica ◽  
Fabrizio Quattrini ◽  
Elena Villaggi ◽  
Rossana Gobbi ◽  
...  
Keyword(s):  
Absorbed Dose ◽  
The Other ◽  
Dominant Hand ◽  
X Rays ◽  
Dose Limit ◽  
Annual Dose ◽  
Radiation Beam ◽  
Orthopaedic Surgeons ◽  
Left Hand ◽  
The Right

Abstract Data were collected from 642 orthopaedic interventions during which the images produced by X-rays were recorded. By examining these images, it is possible to determine the time that the orthopaedic surgeons’ hands were exposed to the direct radiation beam. The procedures with greater exposure to the direct beam were those involving the hand (median 15 s) and the wrist (median 13 s). Two surgeons wore a ring to measure the absorbed dose at the fingers: one on the dominant hand and the other on the non-dominant hand. The two surgeons performed 34 and 48 operations, respectively, in 14 months. The total doses measured with the rings were 2.30 and 1.04 mSv, respectively. The images of the interventions were examined, determining how much each individual hand was exposed. The interventional reference point (IRPeff (left or right)) was calculated by comparing the doses at the IRP with the exposure times of the right or the left hand. Summing the IRPeff of the two surgeons in 14 months, it is obtained the maximum values of 2.87 mGy for the left hand of one and 6.74 mGy for the right hand of the other, which are of the order of 1/100 of the annual dose limit for the extremities.

scholarly journals Radiation exposure in spine surgery using an image-guided system based on intraoperative cone-beam computed tomography: analysis of 107 consecutive cases

2016 ◽  
Vol 25 (5) ◽  
pp. 654-659 ◽  
Author(s):  
Francesco Costa ◽  
Giovanni Tosi ◽  
Luca Attuati ◽  
Andrea Cardia ◽  
Alessandro Ortolina ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Spine Surgery ◽  
Cone Beam ◽  
Radiological Protection ◽  
Consecutive Series ◽  
Surgical Time ◽  
Screw Misplacement ◽  
The Mean ◽  
Tomography Analysis

OBJECTIVE The O-arm system in spine surgery allows greater accuracy, lower rate of screw misplacement, and reduced surgical time. Some concerns have been postulated regarding the radiation doses to patients and surgeons. To the best of the authors' knowledge, most of the studies in the literature were performed with the use of phantoms. The authors present data regarding radiation exposure of the surgeon and operating room (OR) staff in a consecutive series of patients undergoing spine surgery. METHODS Radiation exposure data were collected in a series of 107 patients who underwent spine surgery using the O-arm system. The doses received by the surgeon and the staff were collected using electronic dosimeters. RESULTS All patients underwent 1–3 scans. The mean radiation dose to the patients was 5.15 mSv (range 1.48–7.64 mSv). The mean dose registered for the scan operator was 0.005 μSv (range 0.00–0.03 μSv) while the other members of the surgical team positioned outside the OR received 0 μSv. CONCLUSIONS The O-arm system exposes patients to a higher radiation dose than standard fluoroscopy. However, considering the clear advantages of this system, this adjunctive dose can be considered acceptable. Moreover, the effective dose to the patient can be reduced using collimation or minimizing the parameters of the O-arm system used in this paper. The exposure to operators is essentially negligible when radioprotective garments and protocols are adopted as recommended by the International Commission on Radiological Protection.

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