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Michael Synowitz and Juergen Kiwit


In this study the authors evaluated levels of radiation exposure to surgeons’ protected and unprotected hands during fluoroscopically assisted vertebroplasty.


The amount of radiation administered to 30 patients during 41 procedures in a controlled prospective trial over 6 months was assessed, comparing radiation exposure to the right and left hands in two neurosurgeons. Effective skin doses were evaluated using thermoluminescent finger dosimeters (ring dosimeters). The ratios of finger dosimeter exposure were compared between the glove-protected and unprotected left hands of two surgeons and both unprotected right hands. In addition, dose-area product (DAP) and fluoroscopy times were recorded in all patients.

The mean treatment-effective dose to the surgeons’ hands was 0.49 ± 0.4 mSv in the glove-protected left hand and 1.81 ± 1.31 mSv in the unprotected left hand (p < 0.05). The mean effective hand doses were 0.59 ± 0.55 mSv in the unprotected right hand of the glove-protected surgeon and 0.62 ± 0.55 mSv in the unprotected right hand of the control surgeon. The total corresponding fluoroscopy time was 38.55 minutes for the protected surgeon and 41.23 minutes for the unprotected one (p > 0.05). Lead glove shielding resulted in a radiation dose reduction of 75%. The total DAP for all procedures was 256,496 mGy/cm2 and 221,408 mGy/cm2 (p >0.05) for the protected and unprotected surgeons, respectively.


This study emphasizes the importance of surgeons wearing lead glove protection on their leading hands during percutaneous vertebroplasty procedures and demonstrates a 75% reduction rate of exposure to radiation.

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Rajesh K. Bindal, Sharon Glaze, Meghann Ognoskie, Van Tunner, Robert Malone and Subrata Ghosh

materials or methods used in this study or the findings specified in this paper. Acknowledgment This paper is in memory of Julius Goodman, M.D., teacher, mentor, and friend. References 1 Bindal RK , Ghosh S : Intraoperative electromyography monitoring in minimally invasive transforaminal lumbar interbody fusion . J Neurosurg Spine 6 : 126 – 132 , 2007 2 Chida K , Saito H , Otani H , Kohzuki M , Takahashi S , Yamada S , : Relationship between fluoroscopic time, dose-area product, body weight, and maximum radiation skin dose in

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Robert H. Andres, Thilo Graupner, Christian B. Bärlocher, Arthur Augsburger and Javier Fandino

achieving appropriate sensory and motor stimulation responses, kryorhizotomy was performed as described above. The time of x-ray exposure and dose-area product were measured by a dose monitor chamber (2.8 mm Al absorber, sensitivity > 800 pC/mGy × cm 2 , range 0.1–10 4 mGy × cm 2 /second) integrated in the image intensifier unit and recorded by the Ziehm Vision software during all procedures. Pain severity was rated by the patients using the VAS scale on the day before the intervention, during kryorhizotomy, 6 hours after the procedure, and after 6 months. The accuracy

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Alexander E. Ropper, Ning Lin, Bradley A. Gross, Hekmat K. Zarzour, Ruth Thiex, John H. Chi, Rose Du and Kai U. Frerichs

to ensure that the quality of the acquired dataset was adequate or if further manipulation was required. Radiation exposure was evaluated with cumulative air kerma (in Gy) and dose-area product (DAP, in Gy·cm 2 ), both of which were obtained directly from the angiography station. The cumulative air kerma (or cumulative dose) was measured 15 cm below the isocenter of the fluoroscopy tubing, and the DAP was calculated as the integral of air kerma across the x-ray beam emission. These radiation exposure parameters were routinely recorded for all neuroangiography

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Karam Moon, Andrew F. Ducruet, R. Webster Crowley, Kathleen Klas, Ruth Bristol and Felipe C. Albuquerque

and Follow-Up The patient was noted to have significantly improved headaches within 24 hours. Unfortunately, due to her radiation dose area product of 1,659,643 mGy × cm 2 , she suffered from radiation-induced alopecia, a potential complication that was disclosed in detail prior to the procedure. Two-month follow-up angiography revealed continued obliteration of the fistula ( Fig. 10 ). Additionally, 7-month follow-up angiography revealed stable occlusion. She continues to do well, with only mild headaches and continuing improvement in her cognitive performance

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Marian Gaballah, Phillip B. Storm, Deborah Rabinowitz, Rebecca N. Ichord, Robert W. Hurst, Ganesh Krishnamurthy, Marc S. Keller, Adeka McIntosh and Anne Marie Cahill

were reviewed twice, first via 2-reader consensus, and then re-reviewed via 4-reader consensus to confirm the findings on intraoperative angiography. Statistical Analysis Comparison of dose-area product (DAP) and fluoroscopy times between intraoperative and postoperative angiography was performed using the Mann-Whitney U-test. Statistical significance was determined at p ≤ 0.05. Results Patient Characteristics Seventeen patients met eligibility criteria and were included in the analysis of intraoperative angiography. Patient demographics and clinical

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of a teaching hospital. Methods: We reviewed 172 endovascular procedures performed between December 2014 and May 2015. A collar dosimeter badge (InstadoseTM) was worn by the attending physician (endovascular neurosurgeon) and trainee (neurosurgery resident) for every procedure. Total radiation dosage, Dose Area Product (DAP), Cumulative Air Kerma (CAK), and total fluoroscopy time for the attending and resident physicians were recorded for each procedure. Power injector usage varied depending on surgeon discretion. Physician radiation exposure was then

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Francesco Costa, Giovanni Tosi, Luca Attuati, Andrea Cardia, Alessandro Ortolina, Marco Grimaldi, Fabio Galbusera and Maurizio Fornari

according to necessity. In particular, it is possible to work directly modifying the parameters (for example, peak kilovoltage [kVp] and milliamperes [mA]) or using a manual collimation protocol that allows one to perform adjustment of the collimator shutters. Doses to the patients were extracted directly from the data provided by the O-arm system and comprise fluoroscopy time, kVp, mA/sec, dose area product (expressed as mGy-cm 2 ), CT dose index (CTDI, expressed in mGy), and dose length product (DLP, expressed in computed mGy-cm). These data were considered reliable

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Marc L. Schröder and Victor E. Staartjes

clinical success in VAS-LP was a high BMI (OR 1.4, 95% CI 1–1.9, p = 0.035). No significant predictors were found for achieving an MCID in ODI scores. The Meyerding grade of slippage did not influence outcomes. TABLE 2. Perioperative data and clinical outcomes Characteristic Value Type of surgery  MI-TLIF 54%  MI-PLIF 46% Meyerding grade *  Grade I anterolisthesis 82%  Grade II anterolisthesis 14%  Grade I retrolisthesis 4% Index level  L2–3 1%  L3–4 4%  L4–5 53%  L5–S1 42% Periop data  Estimated blood loss (ml) 336 ± 262  Dose area product (mGy cm 2 ) 306 ± 123

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Andrej Pala, Fadi Awad, Michael Braun, Michal Hlavac, Arthur Wunderlich, Bernd Schmitz, Christian Rainer Wirtz and Jan Coburger

with the parameters of 140 kV and 15 mAs. The dose-length product (DLP; mGy·cm) was used for the CT scans, and the dose-area product (DAP; dGy·cm 2 ) was documented for radiographic images. Both DLP and DAP data were derived as reported by the CT scanner or the flat-panel detector of the radiographic system. Depending on visualization of the shunt, 1 or 2 radiographs per series for skull, chest, and abdomen were obtained. Immobile patients were imaged in the lying position in bed. Effective dose estimation was based on a conversion factor that depends on body regions