Measurements of surgeons' exposure to ionizing radiation dose during intraoperative use of C-arm fluoroscopy.

STUDY DESIGN: Measurement of radiation dose from C-arm fluoroscopy during a simulated intraoperative use in spine surgery. OBJECTIVE.: To investigate scatter radiation doses to specific organs of surgeons during intraoperative use of C-arm fluoroscopy in spine surgery and to provide practical intraoperative guidelines.

SUMMARY OF BACKGROUND DATA: There have been studies that reported the radiation dose of C-arm fluoroscopy in various procedures. However, radiation doses to surgeons' specific organs during spine surgery have not been sufficiently examined, and the practical intraoperative radioprotective guidelines have not been suggested.

METHODS: Scatter radiation dose (air kerma rate) was measured during the use of a C-arm on an anthropomorphic chest phantom on an operating table. Then, a whole body anthropomorphic phantom was located besides the chest phantom to simulate a surgeon, and scatter radiation doses to specific organs (eye, thyroid, breast, and gonads) and direct radiation dose to the surgeon's hand were measured using 4 C-arm configurations (standard, inverted, translateral, and tube translateral). The effects of rotating the surgeon's head away from the patient and of a thyroid shield were also evaluated.

RESULTS: Scatter radiation doses decreased as distance from the patient increased during C-arm fluoroscopy use. The standard and translateral C-arm configurations caused lower scatter doses to sensitive organs than inverted and tube translateral configurations. Scatter doses were highest for breast and lowest for gonads. The use of a thyroid shield and rotating the surgeon's head away from the patient reduced scatter radiation dose to the surgeon's thyroid and eyes. The direct radiation dose was at least 20 times greater than scatter doses to sensitive organs.

CONCLUSION: The following factors could reduce radiation exposure during intraoperative use of C-arm; (1) distance from the patient, (2) C-arm configuration, (3) radioprotective equipments, (4) rotating the surgeons' eyes away from the patient, and (5) avoiding direct exposure of surgeons' hands.