Radiation Exposure to the Surgeon and Patient During a Fluoroscopic Procedure

Yamashita, Kazuo; Higashino, Kosaku; Wada, Keizo; Morimoto, Masatoshi; Abe, Mitsunobu; Takata, Yoichiro; Sakai, Toshinori; Fukui, Yoshihiro; Sairyo, Koichi

doi:10.1097/brs.0000000000001542

Cited by 34 publications

(28 citation statements)

References 7 publications

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“…Therefore, exposure to radiation can be reduced by positioning physicians farther away from the C-arm fluoroscope and patient. It is recommended that pain physicians perform procedures on the side of the image receptor not the side of the X-ray tube while checking lateral fluoroscopy, and that they should keep their hands away from the irradiated area [15]. …”

Section: Discussionmentioning

confidence: 99%

The radiation safety education and the pain physicians' efforts to reduce radiation exposure

et al. 2017

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BackgroundC-arm fluoroscopy equipment is important for interventional pain management and can cause radiation injury to physicians and patients. We compared radiation safety education and efforts to reduce the radiation exposure of pain specialists.MethodsA survey of 49 pain specialists was conducted anonymously in 2016. The questionnaire had 16 questions. That questionnaire was about radiation safety knowledge and efforts to reduce exposure. We investigated the correlation between radiation safety education and efforts of radiation protection. We compared the results from 2016 and a published survey from 2011.ResultsAccording to the 2016 survey, all respondents used C-arm fluoroscopy in pain interventions. Nineteen respondents (39%) had received radiation safety education. Physicians had insufficient knowledge about radiation safety. When the radiation safety education group and the non-education group are compared, there was no significant difference in efforts to reduce radiation exposure and radiation safety knowledge. When the 2011 and 2016 surveys were compared, the use of low dose mode (P = 0.000) and pulsed mode had increased significantly (P = 0.001). The number checking for damage to radiation protective garments (P = 0.000) and use of the dosimeter had also increased significantly (P = 0.009). But there was no significant difference in other efforts to reduce radiation exposure.ConclusionsPain physicians seem to lack knowledge of radiation safety and the number of physicians receiving radiation safety education is low. According to this study, education does not lead to practice. Therefore, pain physicians should receive regular radiation safety education and the education should be mandatory.

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Section: Discussionmentioning

confidence: 99%

The radiation safety education and the pain physicians' efforts to reduce radiation exposure

et al. 2017

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“…[ 26 ] Multiple studies have introduced more advanced fluoroscopy devices to assist an orthopedic surgery, and numerous strategies protection has been proposed to minimize the radiation exposure. [ 27 – 33 ] Lee et al [ 1 ] indicated that following factors could reduce radiation exposure during intraoperative use of C-arm, which included distance from the patient, C-arm configuration, radio-protective equipment, rotating the surgeons’ eyes away from the patient, and avoiding direct exposure of surgeons’ hands. Yu and Khan [ 31 ] found that orthopedic surgeons can decline potential radiation risks by optimizing variables such as the use of barriers, knowledge of position, distance from the radiation source, and use of advanced image guidance navigation-assisted technology.…”

Section: Discussionmentioning

confidence: 99%

“…The fluoroscopically guided technique has provided effective assistance for orthopedic surgery, whose drawback appears to dramatically increase radiation exposure to surgeons as well as other medical staff. [ 1 ] Orthopedic surgeons can be exposed to primary radiation and secondary radiation from iatrogenic X-ray. Primary radiation refers to direct radiation exposure while a surgeon enters the space between x-ray generator and receptor, and secondary radiation mainly refers to scattered radiation.…”

Section: Introductionmentioning

confidence: 99%

“…[ 3 ] The accumulated radiation exposure over time has been reported to be associated with cancer, cataracts and other diseases, [ 4 ] especially the organs sensitive to radiation (eg, gonads, bone marrow, breast, cornea). [ 1 ] Thus, radiation exposure is a great concern for orthopedic surgeons as a special group routinely applying radiation-related technique. [ 5 , 6 ]…”

Section: Introductionmentioning

confidence: 99%

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Knowledge deficiency of work-related radiation hazards associated with psychological distress among orthopedic surgeons

Fan¹,

Wang²,

Guo

et al. 2017

Medicine

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Knowledge and concern degree about work-related radiation hazards remained unknown among orthopedic surgeons. The aim of the cross-sectional study is to investigate whether the knowledge degree of work-related radiation is associated with psychological distress among orthopedic surgeons. This cross-sectional study sent electronic questionnaire via WeChat to orthopedic surgeons nationwide. Concern and knowing degree over radiation exposure was evaluated by a single self-reported question. Professional evaluation of concern degree was reflected by general psychological distress, which was assessed with the Kessler 10 scale (K10) and depressive symptoms with the Center for Epidemiologic Studies Depression Scale (CES-D). Only 43.23% (115/266) respondents knew well about radiation and a total of 78.20% (208/266) respondents considered radiation exposure as a great concern. Among those who reported concerns about radiation exposure, a total of 57.69% (120/208) respondents reported knowing little about radiation. Respondents who reported concerns over radiation exposure were significantly associated with higher scores on CES-D and K10 (P < .05). Among respondents who reported concerns over radiation exposure, those who have fewer knowledge about radiation, had higher CES-D and K10 scores than those who knew well about radiation (P < .05). Among respondents who reported no concerns over radiation exposure, those who knew little about radiation still had higher CES-D and K10 scores (P < .05). Fewer radiation knowledge tends to induce more radiation concerns associated with higher psychological distress in orthopedic surgeons. Radiation knowledge should be enhanced for surgeons who daily work with radiation-related fluoroscopy.

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“…In particular, the surgeon’s hands, thyroid gland, and eyes receive obvious exposure to radiation 15 - 19 . We previously reported on the measurement of radiation with use of cadavers, and the results of that study showed that the measurement of radiation was valid and reproducible 20 .…”

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confidence: 97%

Pulsation and Collimation During Fluoroscopy to Decrease Radiation

Yamashita

Higashino

Hayashi

et al. 2017

JBJS OA

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Background:Awareness of the harmful effects of long-term low-dose radiation is rising. Many studies have assessed both patient and physician exposure to radiation in association with the use of fluoroscopy in the operating room. However, to our knowledge, previous studies have not assessed, in a detailed fashion, the reduction in radiation exposure that pulsation and collimation provide.Methods:Seven fresh cadavers were irradiated for 5 minutes with C-arm fluoroscopy with use of standard x-ray and pulsed and collimated x-ray beams. The x-ray sources were placed under the table, over the table, and lateral to the table. Radiation exposure doses were measured at different points, such as the center of the radiation field on the cadaver as well as at the locations of the surgeon’s hand and thyroid gland. In addition, Monte Carlo simulation (a physics equation to predict exposure) was performed to estimate the dose reduction and to confirm the experimental results.Results:The radiation exposure doses associated with the use of pulsed fluoroscopy (8 times per second) were reduced by approximately 30% for the patient and by approximately 70% for the surgeon’s hand and thyroid gland as compared with those associated with the use of continuous fluoroscopy. The radiation exposure doses associated with the use of collimated beams were reduced to approximately 65% for the surgeon’s hand and thyroid gland as compared with those associated with the use of non-collimated fluoroscopy. These results were consistent with the simulation, and the phenomena could be appropriately explained by physics.Conclusions:The present study revealed the effectiveness of pulsed and collimated x-ray beams in reducing radiation exposure doses resulting from C-arm fluoroscopy. Surgeons should consider using the techniques of pulsed fluoroscopy and collimation to protect patients and themselves from radiation.Clinical Relevance:This study presents data regarding the reduction of radiation exposure provided by pulsed fluoroscopy and collimation.

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Radiation Exposure to the Surgeon and Patient During a Fluoroscopic Procedure

Abstract: 4.

Cited by 34 publications

References 7 publications

The radiation safety education and the pain physicians' efforts to reduce radiation exposure

The radiation safety education and the pain physicians' efforts to reduce radiation exposure

Knowledge deficiency of work-related radiation hazards associated with psychological distress among orthopedic surgeons

Pulsation and Collimation During Fluoroscopy to Decrease Radiation

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