Letters to the Editor
Fluoroscopic Radiation Exposure to Operating Room Personnel in Spinal Surgery To the Editor: It was with great interest that we read the paper entitled “Fluoroscopic radiation exposure in spinal surgery: In vivo evaluation for operating room personnel” by Mulconrey,1 published in the journal recently. This interesting study investigated the fluoroscopic radiation exposure to the operating room personnel during spinal surgery in vivo, and their findings were consistent with other previous study in vitro. However, as we noticed, the study obtained the radiation dosimetry through unprotected badges placed on surgeon’s chest, first assistant chest, and cranial and caudal end of the operating table.1 No dosimetry badges were attached to eyes or hands of surgeons and assistants. Thereafter, the study used the mean dose per minute from the chest and the recommended annual maximum limit (hand 500 mSv;
J Spinal Disord Tech
eye 150 mSv) from the International Commission on Radiologic Protection (IRCP), to calculate annual limit per eye exposure and hand exposure. This was not accurate at all, because the radiation dosage measured from the chest could not represent that from the eyes, let alone the hands. The hands’ radiation exposures were usually much higher than the chest of surgeons, mostly because of the direct beam radiation to the hands.2 Actually, the measured radiation dosages from the chest were often used to calculate whole-body effective dose and the annual limit per whole-body exposure, with the recommended annual maximum limit of the whole body being 50 mSv.3–5 What confused us more was that the study used the radiation dosage from the cranial table and caudle table to calculate the annual limit per eye and per hand (Table 2).1 Finally, we would like to share the updated recommendation from IRCP with peer researchers that for occupational exposure in planned exposure situations, the equivalent dose limit for the lens of the eye should be 20 mSv in a year, averaged over defined periods of 5 year, with exposure not exceeding 50 mSv in any single year.6
Volume 27, Number 8, December 2014
Guoxin Fan, MD, Shan Zhao, MD, Shisheng He, MD, Xin Gu, MD, Xiaofei Guan, MD Spinal Surgery Department, Shanghai Tenth People’s Hospital, Tongji University School of Medicine Shanghai, China
REFERENCES 1. Mulconrey DS. Fluoroscopic radiation exposure in spinal surgery: in vivo evaluation for operating room personnel. J Spinal Disord Tech. 2013. [Epub ahead of print]. doi:10.1097/BSD.0b013e31828673c1. 2. Lee K, Lee KM, Park MS, et al. Measurements of surgeons’ exposure to ionizing radiation dose during intraoperative use of C-arm fluoroscopy. Spine (Phila Pa 1976). 2012;37:1240–1244. 3. Choi HC. Fluoroscopic radiation exposure during percutaneous kyphoplasty. J Korean Neurosurg Soc. 2011;49:37–42. 4. Ahn Y, Kim CH, Lee JH, et al. Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy: a prospective study. Spine (Phila Pa 1976). 2013;38:617–625. 5. Fitousi NT, Efstathopoulos EP, Delis HB, et al. Patient and staff dosimetry in vertebroplasty. Spine (Phila Pa 1976). 2006;31: E884–E889; discussion E890, 6. Thorne MC. Regulating exposure of the lens of the eye to ionising radiations. J Radiol Prot. 2012;32:147–154.
G.F. drafted the manuscript and revised the manuscript; S.Z., X.G., and X.G. gave critical comments; S.H. approved the final version of the manuscript. The authors declare no conflict of interest.
448 | www.jspinaldisorders.com
r
2014 Lippincott Williams & Wilkins
Fluoroscopic Radiation Exposure to Operating Room Personnel in Spinal Surgery To the Editor: It was with great interest that we read the paper entitled “Fluoroscopic radiation exposure in spinal surgery: In vivo evaluation for operating room personnel” by Mulconrey,1 published in the journal recently. This interesting study investigated the fluoroscopic radiation exposure to the operating room personnel during spinal surgery in vivo, and their findings were consistent with other previous study in vitro. However, as we noticed, the study obtained the radiation dosimetry through unprotected badges placed on surgeon’s chest, first assistant chest, and cranial and caudal end of the operating table.1 No dosimetry badges were attached to eyes or hands of surgeons and assistants. Thereafter, the study used the mean dose per minute from the chest and the recommended annual maximum limit (hand 500 mSv;
J Spinal Disord Tech
eye 150 mSv) from the International Commission on Radiologic Protection (IRCP), to calculate annual limit per eye exposure and hand exposure. This was not accurate at all, because the radiation dosage measured from the chest could not represent that from the eyes, let alone the hands. The hands’ radiation exposures were usually much higher than the chest of surgeons, mostly because of the direct beam radiation to the hands.2 Actually, the measured radiation dosages from the chest were often used to calculate whole-body effective dose and the annual limit per whole-body exposure, with the recommended annual maximum limit of the whole body being 50 mSv.3–5 What confused us more was that the study used the radiation dosage from the cranial table and caudle table to calculate the annual limit per eye and per hand (Table 2).1 Finally, we would like to share the updated recommendation from IRCP with peer researchers that for occupational exposure in planned exposure situations, the equivalent dose limit for the lens of the eye should be 20 mSv in a year, averaged over defined periods of 5 year, with exposure not exceeding 50 mSv in any single year.6
Volume 27, Number 8, December 2014
Guoxin Fan, MD, Shan Zhao, MD, Shisheng He, MD, Xin Gu, MD, Xiaofei Guan, MD Spinal Surgery Department, Shanghai Tenth People’s Hospital, Tongji University School of Medicine Shanghai, China
REFERENCES 1. Mulconrey DS. Fluoroscopic radiation exposure in spinal surgery: in vivo evaluation for operating room personnel. J Spinal Disord Tech. 2013. [Epub ahead of print]. doi:10.1097/BSD.0b013e31828673c1. 2. Lee K, Lee KM, Park MS, et al. Measurements of surgeons’ exposure to ionizing radiation dose during intraoperative use of C-arm fluoroscopy. Spine (Phila Pa 1976). 2012;37:1240–1244. 3. Choi HC. Fluoroscopic radiation exposure during percutaneous kyphoplasty. J Korean Neurosurg Soc. 2011;49:37–42. 4. Ahn Y, Kim CH, Lee JH, et al. Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy: a prospective study. Spine (Phila Pa 1976). 2013;38:617–625. 5. Fitousi NT, Efstathopoulos EP, Delis HB, et al. Patient and staff dosimetry in vertebroplasty. Spine (Phila Pa 1976). 2006;31: E884–E889; discussion E890, 6. Thorne MC. Regulating exposure of the lens of the eye to ionising radiations. J Radiol Prot. 2012;32:147–154.
G.F. drafted the manuscript and revised the manuscript; S.Z., X.G., and X.G. gave critical comments; S.H. approved the final version of the manuscript. The authors declare no conflict of interest.
448 | www.jspinaldisorders.com
r
2014 Lippincott Williams & Wilkins
