Journal of Radiation Protection and Research

The Korean Association for Radiation Protection (대한방사선방어학회)
권호 표지
DOI QR코드

DOI QR Code

Radiation Dose Distribution of a Surgeon and Medical Staff during Orthopedic Balloon Kyphoplasty in Japan

  • Ono, Koji (Division of Nursing, Faculty of Nursing, Tokyo Healthcare University) ;
  • Kumasawa, Takafumi (National Hospital Organization Disaster Medical Center) ;
  • Shimatani, Keiichi (Center for Preventive Medical Sciences, Chiba University) ;
  • Kanou, Masatoshi (National Hospital Organization Hokkaido Medical center) ;
  • Yamaguchi, Ichiro (Department of Environmental Health,National Institute of Public Health) ;
  • Kunugita, Naoki (Department of Occupational and Community Health Nursing, School of Health Sciences,University of Occupational and Environmental Health)
  • Received : 2021.08.04
  • Accepted : 2022.03.24
  • Published : 2022.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The present study investigated the radiation dose distribution of balloon kyphoplasty (BKP) among surgeons and medical staff, and this is the first research to observe such exposure in Japan. Materials and Methods: The study subjects were an orthopedic surgeon (n = 1) and surgical staff (n = 9) who intervened in BKP surgery performed at the National Hospital Organization Disaster Medical Center (Tokyo, Japan) between March 2019 and October 2019. Only disposable protective gloves (0.022 mmPb equivalent thickness or less) and trunk protectors were used, and no protective glasses or thyroid drapes were used. Results and Discussion: The surgery time per vertebral body was 36.2 minutes, and the fluoroscopic time was 6.8 minutes. The average exposure dose per vertebral body was 1.46 mSv for the finger (70 ㎛ dose equivalent), 0.24 mSv for the lens of the eye (3 mm dose equivalent), 0.11 mSv for the neck (10 mm dose equivalent), and 0.03 mSv for the chest (10 mm dose equivalent) under the protective suit.The estimated cumulative radiation exposure dose of 23 cases of BKP was calculated to be 50.37 mSv for the fingers, 8.27 mSv for the lens, 3.91 mSv for the neck, and 1.15 mSv for the chest. Conclusion: It is important to know the exposure dose of orthopedic surgeons, implement measures for exposure reduction, and verify the safety of daily use of radiation during surgery and examination.

Keywords

Acknowledgement

This work was supported in part by the Industrial Disease Clinical Research, Japan. N. Kunugita was supported by Japanese Ministry of Health, Labour and Welfare (Grant No. 180501-1). We thank Dr. H. Matsuzaki, Mr. S. Kagayama, and Mr. H. Yoshida in National Hospital Organization Disaster Medical Center for their coordination, supervision, and data collection. We also appreciate Ms. Ichika and the medical staff in National Hospital Organization Disaster Medical Center for their study support.

References

  1. Ministry of Health, Labour and Welfare. Ionizing radiation hazard prevention rules related to medical staff [Internet]. Tokyo, Japan: Ministry of Health, Labour and Welfare; 2018 [cited 2022 Apr 25]. Available from: https://www.mhlw.go.jp/file/05-Shingikai-10801000-Iseikyoku-Soumuka/0000191785.pdf.
  2. International Commission on Radiological Protection. Statement on tissue reactions [Internet]. Ottawa, Canada: International Commission on Radiological Protection; 2011 [cited 2022 Apr 25]. Available from: https://www.icrp.org/docs/ICRPStatementonTissueReactions.pdf.
  3. Authors on behalf of ICRP, Stewart FA, Akleyev AV, Hauer-Jensen M, Hendry JH, Kleiman NJ, et al. ICRP publication 118: ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs: threshold doses for tissue reactions in a radiation protection context. Ann ICRP. 2012;41(1-2):1-322. https://doi.org/10.1016/j.icrp.2012.02.001
  4. International Atomic Energy Agency. Radiation protection and safety of radiation sources: international basic safety standards (No. GSR Part 3) [Internet]. Vienna, Austria: International Atomic Energy Agency; 2014 [cited 2022 Apr 25]. Available from: https://www-pub.iaea.org/MTCD/publications/PDF/Pub1578_web57265295.pdf.
  5. Mastrangelo G, Fedeli U, Fadda E, Giovanazzi A, Scoizzato L, Saia B. Increased cancer risk among surgeons in an orthopaedic hospital. Occup Med (Lond). 2005;55(6):498-500. https://doi.org/10.1093/occmed/kqi048
  6. Bouza C, Lopez T, Magro A, Navalpotro L, Amate JM. Efficacy and safety of balloon kyphoplasty in the treatment of vertebral compression fractures: a systematic review. Eur Spine J. 2006;15(7):1050-1067. https://doi.org/10.1007/s00586-005-0048-x
  7. Taylor RS, Taylor RJ, Fritzell P. Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety. Spine (Phila Pa 1976). 2006;31(23):2747-2755. https://doi.org/10.1097/01.brs.0000244639.71656.7d
  8. Taylor RS, Fritzell P, Taylor RJ. Balloon kyphoplasty in the management of vertebral compression fractures: an updated systematic review and meta-analysis. Eur Spine J. 2007;16(8):1085-1100. https://doi.org/10.1007/s00586-007-0308-z
  9. Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, et al. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet. 2009;373(9668):1016-1024. https://doi.org/10.1016/S0140-6736(09)60010-6
  10. Klazen CA, Lohle PN, de Vries J, Jansen FH, Tielbeek AV, Blonk MC, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. 2010;376(9746):1085-1092. https://doi.org/10.1016/S0140-6736(10)60954-3
  11. Boszczyk BM, Bierschneider M, Panzer S, Panzer W, Harstall R, Schmid K, et al. Fluoroscopic radiation exposure of the kyphoplasty patient. Eur Spine J. 2006;15(3):347-355. https://doi.org/10.1007/s00586-005-0952-0
  12. Perisinakis K, Damilakis J, Theocharopoulos N, Papadokostakis G, Hadjipavlou A, Gourtsoyiannis N. Patient exposure and associated radiation risks from fluoroscopically guided vertebroplasty or kyphoplasty. Radiology. 2004;232(3):701-707. https://doi.org/10.1148/radiol.2323031412
  13. Seibert JA. Vertebroplasty and kyphoplasty: do fluoroscopy operators know about radiation dose, and should they want to know? Radiology. 2004;232(3):633-634. https://doi.org/10.1148/radiol.2323040968
  14. Ortiz AO, Natarajan V, Gregorius DR, Pollack S. Significantly reduced radiation exposure to operators during kyphoplasty and vertebroplasty procedures: methods and techniques. AJNR Am J Neuroradiol. 2006;27(5):989-994.
  15. Ishigaki D, Kato Y, Toyono S. Direct radiation exposure during hand surgery. J Jpn Soc Surg Hand. 2015;31:755-758.
  16. Riley SA. Radiation exposure from fluoroscopy during orthopedic surgical procedures. Clin Orthop Relat Res. 1989;(248):257-260.
  17. Singer G. Radiation exposure to the hands from mini C-arm fluoroscopy. J Hand Surg Am. 2005;30(4):795-797. https://doi.org/10.1016/j.jhsa.2005.01.007
  18. Ministry of Health, Labour and Welfare. Current radiation exposure situation in the medical field and the effectiveness of dose reduction [Internet]. Tokyo, Japan: Ministry of Health, Labour and Welfare; 2019 [cited 2022 Apr 25]. Available from: https://www.mhlw.go.jp/content/11201000/000477751.pdf.
  19. Burns S, Thornton R, Dauer LT, Quinn B, Miodownik D, Hak DJ. Leaded eyeglasses substantially reduce radiation exposure of the surgeon's eyes during acquisition of typical fluoroscopic views of the hip and pelvis. J Bone Joint Surg Am. 2013;95(14):1307-1311. https://doi.org/10.2106/JBJS.L.00893
  20. Romanova K, Vassileva J, Alyakov M. Radiation exposure to the eye lens of orthopaedic surgeons during various orthopaedic procedures. Radiat Prot Dosimetry. 2015;165(1-4):310-313. https://doi.org/10.1093/rpd/ncv122
  21. Haga Y, Chida K, Kaga Y, Sota M, Meguro T, Zuguchi M. Occupational eye dose in interventional cardiology procedures. Sci Rep. 2017;7(1):569. https://doi.org/10.1038/s41598-017-00556-3
  22. Endo M, Haga Y, Sota M, Tanaka A, Otomo K, Murabayashi Y, et al. Evaluation of novel X-ray protective eyewear in reducing the eye dose to interventional radiology physicians. J Radiat Res. 2021;62(3):414-419. https://doi.org/10.1093/jrr/rrab014
  23. Klingler JH, Hoedlmoser H, Naseri Y. Radiation protection measures to reduce the eye lens dose in spinal surgery. Spine J. 2021;21(8):1243-1245. https://doi.org/10.1016/j.spinee.2021.04.002
  24. Synowitz M, Kiwit J. Surgeon's radiation exposure during percutaneous vertebroplasty. J Neurosurg Spine. 2006;4(2):106-109. https://doi.org/10.3171/spi.2006.4.2.106