Radiation exposure during scoliosis surgery: a prospective study

BACKGROUND CONTEXT

The present literature on the cancer risks related to radiation exposure in patients and surgeons during scoliosis surgery is sparse.

PURPOSE

To assess the radiation exposure in patients and surgeons during scoliosis surgery and estimate the increased cancer risk of both groups.

STUDY DESIGN

Over a 6-month period, we conducted a prospective study to monitor the intraoperative radiation dose received by both patients and surgeons during scoliosis cases.

PATIENT SAMPLE

It included 30 consecutive patients undergoing scoliosis surgery by a team of two surgeons (S1 and S2).

OUTCOME MEASURES

We measured the radiation exposure to the eyes, thyroid, and hands for each surgeon; measured the difference of radiation exposure between the two surgeons; the difference in radiation exposure with respect to the proximity of the surgeon to the X-ray tube, and the radiation exposure for each patient.

METHODS

An electronic dosimeter was attached over the thyroid guard and a thermoluminescent dosimeter ring on both hands of each surgeon. The patients were monitored using the dose area product (DAP) measurements from the image intensifier, and their radiation exposure was calculated with the Monte Carlo calculation.

RESULTS

The mean eye dose per procedure for the two surgeons S1 and S2 was 0.8 μSv and 1.3 μSv, respectively. The mean thyroid dose for S2 and S1 was 1.2 μSv and 1.4 μSv, respectively. The dose recorded by the surgeon on the same side of the patient as the X-ray tube was significantly higher than for the surgeon on the far side (p<.05). Mean DAP per procedure was 91.3 cGycm(2) and the mean radiation dose for patients was 252.9 μSv. The increase in cancer risk for patients and surgeons was 0.001% and 0.0005%, respectively, for each year of exposure.

CONCLUSIONS

A significantly higher dose of radiation during scoliosis surgery was received by the surgeon standing on the same side as the X-ray tube. However, both surgeons received a total radiation dose of less than 1% of the recommended dose limit per year and, therefore, the total radiation exposure in both surgeons and patients was well within the recommended safe limits.

Value of lymphocyte counts as a prognostic index of survival following femoral neck fractures

In a retrospective study of patients with hip fractures, the preoperative lymphocyte counts of 62 patients who had died before discharge were compared with those of 64 patients who had survived for at least 6 months. It was found that the lymphocyte count was below the normal range (1.5-4.0 x 10(9)/l) in 82 per cent of those patients who died but only 36 per cent of those who survived. This difference is highly significant (P less than 0.001). It is suggested that the total lymphocyte count is valuable as an easily estimated prognostic index to identify the subgroup of patients who are at increased risk of dying from this injury.