Surgeon and staff radiation exposure in minimally invasive spinal surgery: prospective series using a personal dosimeter

Restricted access

OBJECTIVE

The level of radiation awareness by surgeons and residents in spinal surgery does not match the ubiquity of fluoroscopy in operating rooms in the United States. The present method of monitoring radiation exposure may contribute to the current deficiency in radiation awareness. Current dosimeters involve a considerable lag from the time that the surgical team is exposed to radiation to the time that they are provided with that exposure data. The objective of the current study was to assess the feasibility of monitoring radiation exposure in operating room personnel during lateral transpsoas lumbar interbody fusion (LLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) procedures by using a wearable personal device with real-time feedback.

METHODS

Operating room staff participating in minimally invasive surgical procedures under a single surgeon during a 6-month period were prospectively enrolled in this study. All radiation dose exposures were recorded for each member of the surgical team (surgeon, assistant surgeon, scrub nurse, and circulating nurse) using a personal dosimeter (DoseAware). Radiation doses were recorded in microsieverts (μSv). Comparisons between groups were made using ANOVA with the Tukey post hoc test and Student t-test.

RESULTS

Thirty-nine patients underwent interbody fusions: 25 underwent LLIF procedures (14 LLIF alone, 11 LLIF with percutaneous screw placement [PSP]) and 14 underwent MI-TLIF. For each operative scenario per spinal level, the surgeon experienced significantly higher (p < 0.035) average radiation exposure (LLIF: 167.9 μSv, LLIF+PSP: 424.2 μSv, MI-TLIF: 397.9 μSv) than other members of the team, followed by the assistant surgeon (LLIF: 149.7 μSv, LLIF+PSP: 242.3 μSv, MI-TLIF: 274.9 μSv). The scrub nurse (LLIF: 15.4 μSv, LLIF+PSP: 125.7 μSv, MI-TLIF: 183.0 μSv) and circulating nurse (LLIF: 1.2 μSv, LLIF+PSP: 9.2 μSv, MI-TLIF: 102.3 μSv) experienced significantly lower exposures. Radiation exposure was not correlated with the patient’s body mass index (p ≥ 0.233); however, it was positively correlated with increasing patient age (p ≤ 0.004).

CONCLUSIONS

Real-time monitoring of radiation exposure is currently feasible and shortens the time between exposure and the availability of information regarding that exposure. A shortened feedback loop that offers more reliable and immediate data would conceivably raise the level of concern for radiation exposure in spinal surgeries and could alter patterns of behavior, leading to decreased exposures. Further studies are ongoing to determine the effect of real-time dosimetry in spinal surgery.

ABBREVIATIONS ALARA = as low as is reasonably achievable; BMI = body mass index; LLIF = lateral lumbar interbody fusion; MI-TLIF = minimally invasive transforaminal lumbar interbody fusion; PSP = percutaneous screw placement.
Article Information

Contributor Notes

Correspondence Luis M. Tumialán: c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ. neuropub@barrowneuro.org.INCLUDE WHEN CITING Published online February 7, 2020; DOI: 10.3171/2019.11.SPINE19448.Disclosures Dr. Tumialán is a consultant for Medtronic and has ownership in LessRay.
Headings
References
  • 1

    Figà-Talamanca I: Occupational risk factors and reproductive health of women. Occup Med (Lond) 56:5215312006

  • 2

    Figà-Talamanca I: Reproductive problems among women health care workers: epidemiologic evidence and preventive strategies. Epidemiol Rev 22:2492602000

    • Search Google Scholar
    • Export Citation
  • 3

    Funao HIshii KMomoshima SIwanami AHosogane NWatanabe K: Surgeons’ exposure to radiation in single- and multi-level minimally invasive transforaminal lumbar interbody fusion; a prospective study. PLoS One 9:e952332014

    • Search Google Scholar
    • Export Citation
  • 4

    Goldberg MSMayo NELevy ARScott SCPoîtras B: Adverse reproductive outcomes among women exposed to low levels of ionizing radiation from diagnostic radiography for adolescent idiopathic scoliosis. Epidemiology 9:2712781998

    • Search Google Scholar
    • Export Citation
  • 5

    Interagency Working Group on Medical Radiation: Federal Guidance Report No. 14. Radiation Protection Guidance for Diagnostic and Interventional X-Ray Procedures. Washington, DC: U.S. Environmental Protection Agency2014 (https://www.epa.gov/radiation/federal-guidance-report-no-14-radiation-protection-guidance-diagnostic-and-interventional) [Accessed December 6 2019]

    • Search Google Scholar
    • Export Citation
  • 6

    Khan NRClark AJLee SLVenable GTRossi NBFoley KT: Surgical outcomes for minimally invasive vs open transforaminal lumbar interbody fusion: an updated systematic review and meta-analysis. Neurosurgery 77:8478742015

    • Search Google Scholar
    • Export Citation
  • 7

    Lintmeijer LLvan Soest AJRobbers FSHofmijster MJBeek PJ: Real-time feedback on mechanical power output: facilitating crew rowers’ compliance with prescribed training intensity. Int J Sports Physiol Perform 14:3033092018

    • Search Google Scholar
    • Export Citation
  • 8

    Mohapatra AGreenberg RKMastracci TMEagleton MJThornsberry B: Radiation exposure to operating room personnel and patients during endovascular procedures. J Vasc Surg 58:7027092013

    • Search Google Scholar
    • Export Citation
  • 9

    Müller MCWelle KStrauss ANaehle PCPennekamp PHWeber O: Real-time dosimetry reduces radiation exposure of orthopaedic surgeons. Orthop Traumatol Surg Res 100:9479512014

    • Search Google Scholar
    • Export Citation
  • 10

    Nelson EMMonazzam SMKim KDSeibert JAKlineberg EO: Intraoperative fluoroscopy, portable X-ray, and CT: patient and operating room personnel radiation exposure in spinal surgery. Spine J 14:298529912014

    • Search Google Scholar
    • Export Citation
  • 11

    Ordiales JMNogales JMSánchez-Casanueva RVano EFernández JMÁlvarez FJ: Reduction of occupational radiation dose in staff at the cardiac catheterisation laboratory by protective material placed on the patient. Radiat Prot Dosimetry 165:2722752015

    • Search Google Scholar
    • Export Citation
  • 12

    Racadio JNachabe RCarelsen BRacadio JHilvert NJohnson N: Effect of real-time radiation dose feedback on pediatric interventional radiology staff radiation exposure. J Vasc Interv Radiol 25:1191262014

    • Search Google Scholar
    • Export Citation
  • 13

    Sanchez RVano EFernandez JMGallego JJ: Staff radiation doses in a real-time display inside the angiography room. Cardiovasc Intervent Radiol 33:121012142010

    • Search Google Scholar
    • Export Citation
  • 14

    Slegers ASGültuna IAukes JAvan Gorp EJBlommers FMNiehof SP: Coaching reduced the radiation dose of pain physicians by half during interventional procedures. Pain Pract 15:4004062015

    • Search Google Scholar
    • Export Citation
  • 15

    Taher FHughes APSama AAZeldin RSchneider RHolodny EI: 2013 Young Investigator Award winner: How safe is lateral lumbar interbody fusion for the surgeon? A prospective in vivo radiation exposure study. Spine (Phila Pa 1976) 38:138613922013

    • Search Google Scholar
    • Export Citation
  • 16

    Wrixon AD: New ICRP recommendations. J Radiol Prot 28:1611682008

  • 17

    Yu EKhan SN: Does less invasive spine surgery result in increased radiation exposure? A systematic review. Clin Orthop Relat Res 472:173817482014

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 765 765 765
Full Text Views 57 57 57
PDF Downloads 33 33 33
EPUB Downloads 0 0 0
PubMed
Google Scholar