Fluoroscopic cranial radiation exposure in spine surgery: A prospective single-center evaluation in operating room personnel

Laila Malani Mohammad, James Messegee, M. Omar Chohan, Christopher L. Taylor

Research output: Contribution to journalArticle

Abstract

Background: Cranial radiation exposure during instrumented spine surgery is not well documented. We set out to measure this risk to the patient, surgeon, surgical resident, and scrub technician during these procedures. Methods: Forty-seven individuals were enrolled during a 1.5-year period between October 2014 and March 2016 at the University of New Mexico Department of Neurosurgery. Radiation doses were obtained through electronic dosimeters placed on the surgical cap over the temporal scalp (bilaterally on surgeon and resident assist, unilaterally on surgical scrub on the side facing radiation source) and on the midline of the patient’s exposed cranium. Results: Of the 47 procedures, 39 (83%) were open and 8 (17%) were minimally invasive or percutaneous instrumented procedures. A total of 91 motion segments were treated, with a mean of 1.9 levels per case (57% lumbosacral, 34% cervical, and 2.1% thoracic). Total fluoroscopic time was 12.9 minutes. Mean dose per case (mrem/ case) was calculated for the spine surgeon (1.4), resident assist (1.4), surgical scrub (1.2), and the patient (3.6). All doses were within federal safety guidelines. A spine surgeon would need to perform more than 1400 cases per year to reach the current federal maximum permissible dose for head exposure. Conclusions: There was no difference in cranial radiation exposure between operating room staff during spine surgeries. Moreover, the doses measured at the cranium were within national safety limits. Current protective technologies have significantly reduced the amount of ionizing radiation exposure during routine spine procedures; however, changes in behavior or equipment may further reduce radiation exposure to health care workers. Clinical Relevance: Radiation exposure to patients and hospital staff remains a major concern in the practice of modern spine surgery. Cranial exposure remains the only established environmental risk factor for brain tumors, such as gliomas and meningiomas. Our study shows that all those exposed to radiation during spine surgery had cranial doses well within the national safety limits.

Original languageEnglish (US)
Pages (from-to)28-32
Number of pages5
JournalInternational Journal of Spine Surgery
Volume13
Issue number1
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Operating Rooms
Spine
Radiation
Safety
Skull
Background Radiation
Neurosurgery
Meningioma
Ionizing Radiation
Radiation Exposure
Scalp
Brain Neoplasms
Glioma
Thorax
Head
Guidelines
Technology
Delivery of Health Care
Equipment and Supplies
Surgeons

Keywords

  • Cranial radiation
  • Exposure
  • Radiation
  • Spinal surgery

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Fluoroscopic cranial radiation exposure in spine surgery : A prospective single-center evaluation in operating room personnel. / Mohammad, Laila Malani; Messegee, James; Chohan, M. Omar; Taylor, Christopher L.

In: International Journal of Spine Surgery, Vol. 13, No. 1, 01.01.2019, p. 28-32.

Research output: Contribution to journalArticle

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abstract = "Background: Cranial radiation exposure during instrumented spine surgery is not well documented. We set out to measure this risk to the patient, surgeon, surgical resident, and scrub technician during these procedures. Methods: Forty-seven individuals were enrolled during a 1.5-year period between October 2014 and March 2016 at the University of New Mexico Department of Neurosurgery. Radiation doses were obtained through electronic dosimeters placed on the surgical cap over the temporal scalp (bilaterally on surgeon and resident assist, unilaterally on surgical scrub on the side facing radiation source) and on the midline of the patient’s exposed cranium. Results: Of the 47 procedures, 39 (83{\%}) were open and 8 (17{\%}) were minimally invasive or percutaneous instrumented procedures. A total of 91 motion segments were treated, with a mean of 1.9 levels per case (57{\%} lumbosacral, 34{\%} cervical, and 2.1{\%} thoracic). Total fluoroscopic time was 12.9 minutes. Mean dose per case (mrem/ case) was calculated for the spine surgeon (1.4), resident assist (1.4), surgical scrub (1.2), and the patient (3.6). All doses were within federal safety guidelines. A spine surgeon would need to perform more than 1400 cases per year to reach the current federal maximum permissible dose for head exposure. Conclusions: There was no difference in cranial radiation exposure between operating room staff during spine surgeries. Moreover, the doses measured at the cranium were within national safety limits. Current protective technologies have significantly reduced the amount of ionizing radiation exposure during routine spine procedures; however, changes in behavior or equipment may further reduce radiation exposure to health care workers. Clinical Relevance: Radiation exposure to patients and hospital staff remains a major concern in the practice of modern spine surgery. Cranial exposure remains the only established environmental risk factor for brain tumors, such as gliomas and meningiomas. Our study shows that all those exposed to radiation during spine surgery had cranial doses well within the national safety limits.",
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