Incidence of X-rays exposure in spinal surgeries
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Published:
Aug 5, 2019
Keywords:
Spinal surgery, fluoroscopy, adverse event, complications, protection
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Abstract
AbstractBackground: Intraoperative radiographic control (IRC) is an increasingly common practice, but it causes certain adverse events for healthcare providers.Objectives: To measure the use of fluoroscopy in spinal surgery, recognize control measures, evaluate assimilation of protection elements by surgeons, and analyze adverse events for spinal surgeons.Materials and Methods: A survey of 17 multiple-choice questions was e-mailed to spinal surgeons.Results: 55 surveys were answered. More than 60% of surgeons were spinal surgeons. The C-arm is the most widely used machine for final control by pulsating X-rays. Real-time controls are carried out in 31% of cases. One-piece leaded aprons are the most commonly used method, but it is unknown when they should be replaced. Half of the respondents uses more than one protection element. There were seven cases of vision changes, 5 of thyroid disorders, 3 of dermatitis, and 2 of infertility. Three surgeons required surgery for thyroid nodules, cataracts or neoplasm.Conclusions: IRC is a common practice in spinal surgery. One-piece leaded aprons are the most commonly used method and they are often combined with other elements, but it is not known when aprons must be replaced. One in 3 surgeons suffered from the studied conditions, and there were 3 related surgeries. Lack of adequate protection and control is a reality for specialist surgeons, together with a lack of protocols, making this an unregulated issue.
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How to Cite
Bazán, P. L., Muscia, R., Gomez Cano, J., Corrales Pinto, J., Borri, Álvaro E., Medina, M., & Ciccioli, N. M. (2019). Incidence of X-rays exposure in spinal surgeries. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 84(3), 208-215. https://doi.org/10.15417/issn.1852-7434.2019.84.3.884
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Clinical Research
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References
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15. Li J, Lin J, Xu J, Meng H, Su N, Fan Z, et al. Novel approach for percutaneous vertebroplasty based on preoperative CT-based 3-Dimensional model design. World Neurosurg 2017;105:20-6. https://doi.org/10.1016/j.wneu.2017.05.087
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2. Mastrangelo G, Fedeli U, Fadda E, Giovanazzi A, Scoizzato L, Saia B. Increased cancer risk among surgeons in an orthopaedic hospital. Occupational Medicine 2005;55:498-500. https://doi/org/10.1093/occmed/kqi048
3. Frazier TH, Richardson JB, Fabre VC, Callen JP. Fluoroscopy-induced chronic radiation skin injury. A disease perhaps often overlooked. Arch Dermatol 2007;143(5):637-40. https://doi.org/10.1001/archderm.143.5.637
4. Vanoli F, Gentile L, Iglesias SL, Lobos Centeno E, Diaz MP, Allende Nores C. Exposición a la radiación de los cirujanos en la fijación interna de fracturas de radio distal. Rev Asoc Argent Ortop Traumatol 2017;82(4):271-7. http://dx.doi.org/10.15417/674
5. El Tecle NE, El Ahmadieh TY, Patel BM, Lall RR, Bendok BR, Smith ZA. Minimizing radiation exposure in minimally invasive spine surgery. Neurosurg Clin North Am 2014;25:247-60. http://dx.doi.org/10.1016/j.nec.2013.12.004
6. Chang LA, Miller DL, Lee Ch, Melo DR, Villoing D, Drozdovitch V, et al. Thyroid radiation dose to patients from diagnostic radiology procedures over eight decades: 1930-2010. Health Phys 2017;113(6):458-73. https://doi.org/ 10.1097/HP.0000000000000723
7. Kim TT, Johnson JP, Pashman R, Drazin D. Clinical study minimally invasive spinal surgery with intraoperative image-guided navigation. Biomed Res Int 2016. http://dx.doi.org/10.1155/2016/5716235
8. Karami V, Zabihzadeh M. Beam collimation during lumbar spine radiography: a retrospective study. J Biomed Phys Eng 2017;7(2):101-6.
9. Chou LB, Chandran S, Harris AH, Tung J, Butler LM. Increased breast cancer prevalence among female orthopedic surgeon. J Women Health (Larchmt) 2012;21(6):683-9. https://doi.org/10.1089/jwh.2011.3342
10. Klingler J-H, Sircar R, Scheiwe C, Kogias E, Krüger MT, Scholz C, et al. Comparative study of C-arms for intraoperative 3-dimensional imaging and navigation in minimally invasive spine surgery Part II: Radiation exposure. Clin Spine Surg 2017;30(6):E669-E676. https://doi.org/10.1097/BSD.0000000000000187
11. Li X, Zhang Y, Zhang Q, Zhao C, Liu K. Clinical application of a drill guide template for pedicle screw placement in severe scoliosis. Acta Ortop Bras 2017;25(2):67-70. https://doi.org/ 10.1590/1413-785220172502138828
12. Zhang W, Li H, Zhou Y, Wang J, Chu T, Zheng W, et al. Minimally invasive posterior decompression combined with percutaneous pedicle screw fixation for the treatment of thoracolumbar fractures with neurological deficits. Spine (Phila PA 1976) 2016;41(Suppl 19):B23-B29. https://doi.org/10.1097/BRS.0000000000001814
13. Wu R, Liao X, Xia H. Radiation exposure to the surgeon during ultrasound-assisted transforaminal percutaneous endoscopic lumbar discectomy: a prospective study. World Neurosurg 2017;101:658-665. https://doi.org/10.1016/j.wneu.2017.03.050
14. Nascimento A, Defino H, Silva M, Araújo J, Ronaldo LF. Comparison of exposure to radiation during percutaneous transpedicular procedures, using three fluoroscopic techniques. Coluna/Columna 2017;16(2):141-4. http://dx.doi.org/10.1590/s1808-185120171602178378
15. Li J, Lin J, Xu J, Meng H, Su N, Fan Z, et al. Novel approach for percutaneous vertebroplasty based on preoperative CT-based 3-Dimensional model design. World Neurosurg 2017;105:20-6. https://doi.org/10.1016/j.wneu.2017.05.087
16. Kraus M, von dem Berge PM, Krischak G, Weckbach S. Accuracy of screw placement and radiation dose in navigated dorsal instrumentation of the cervical spine: a prospective cohort study. Int J Med Robot 2014;10(2):223-9. https://doi.org/10.1002/rcs.1555