scholarly journals Comparison of Radiation Exposure of AIRO Intraoperative CT with C-Arm Fluoroscopy during Posterior Lumbar Interbody Fusion

2021 ◽  
Vol 11 (21) ◽  
pp. 10326
Author(s):  
Brecht Van Berkel ◽  
Gwendolien Smets ◽  
Gertjan Van Schelverghem ◽  
Elien Houben ◽  
Dieter Peuskens ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Effective Dose ◽  
Operating Room ◽  
Lumbar Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Pedicle Screw Fixation ◽  
Navigation Systems ◽  
Intraoperative Computed Tomography ◽  
Minimally Invasive Spine ◽  
Operating Room Staff

Navigation systems used during minimally invasive spine procedures have evolved from uniplanar, two-dimensional C-arm fluoroscopy to multiplanar, 3D intraoperative computed tomography (iCT). In this study, the radiation exposure to the patient and operating room staff in posterior intervertebral lumbar fusion procedures is compared between iCT and C-arm fluoroscopy. The effective dose of the surgeon, operating nurse, and anesthesiologist was measured during surgery with personal dosimeters, and the effective dose of the patient was measured with GafchromicTM films. The time efficiency of the procedure was evaluated by recording the duration of pedicle screw fixation and the duration of the total surgery time. A total of 75 patients participated in the study; 30 patients had surgery guided by iCT and 45 by C-arm fluoroscopy. The radiation dose of the surgeon, the operating nurse, and the anesthesiologist was thirteen fold lower with surgeries assisted by iCT compared to C-arm fluoroscopy. In contrast, the effective dose of the patient significantly increased with iCT. Using iCT, radiation exposure of the operating room staff can be significantly reduced. iCT increases the effective dose of the patient and prolongs the operative time.

Pedicle screw fixation for isthmic spondylolisthesis: does posterior lumbar interbody fusion improve outcome over posterolateral fusion?

2003 ◽  
Vol 99 (2) ◽  
pp. 143-150 ◽  
Author(s):  
Giovanni La Rosa ◽  
Alfredo Conti ◽  
Fabio Cacciola ◽  
Salvatore Cardali ◽  
Domenico La Torre ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Pedicle Screw Fixation ◽  
Posterolateral Fusion ◽  
Lumbar Interbody Fusion ◽  
Isthmic Spondylolisthesis ◽  
Content Type ◽  
Fine Print

Object. Posterolateral fusion involving instrumentation-assisted segmental fixation represents a valid procedure in the treatment of lumbar instability. In cases of anterior column failure, such as in isthmic spondylolisthesis, supplemental posterior lumbar interbody fusion (PLIF) may improve the fusion rate and endurance of the construct. Posterior lumbar interbody fusion is, however, a more demanding procedure and increases costs and risks of the intervention. The advantages of this technique must, therefore, be weighed against those of a simple posterior lumbar fusion. Methods. Thirty-five consecutive patients underwent pedicle screw fixation for isthmic spondylolisthesis. In 18 patients posterior lumbar fusion was performed, and in 17 patients PLIF was added. Clinical, economic, functional, and radiographic data were assessed to determine differences in clinical and functional results and biomechanical properties. At 2-year follow-up examination, the correction of subluxation, disc height, and foraminal area were maintained in the group in which a PLIF procedure was performed, but not in the posterolateral fusion—only group (p < 0.05). Nevertheless, no statistical intergroup differences were demonstrated in terms of neurological improvement (p = 1), economic (p = 0.43), or functional (p = 0.95) outcome, nor in terms of fusion rate (p = 0.49). Conclusions. The authors' findings support the view that an interbody fusion confers superior mechanical strength to the spinal construct; when posterolateral fusion is the sole intervention, progressive loss of the extreme correction can be expected. Such mechanical insufficiency, however, did not influence clinical outcome.

Reduced radiation fluoroscopy technique for implantation of sacral neuromodulation

2021 ◽  
pp. 205141582110029
Author(s):  
Jason Groegler ◽  
Mohammad Hajiha ◽  
Hillary Wagner ◽  
Forrest Jellison ◽  
Akin S Amasyali ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Operating Room ◽  
Low Dose ◽  
Sacral Neuromodulation ◽  
Level Of Evidence ◽  
Lead Placement ◽  
Significant Difference ◽  
Fluoroscopic Imaging ◽  
Effects Of Radiation ◽  
Operating Room Staff

Introduction: Sacral neuromodulation (SNM) is a Food and Drug Administration–approved treatment option for urinary urgency and fecal incontinence. Fluoroscopic imaging is used at various steps during lead placement, which exposes the operating room staff and patient to the harmful effects of radiation. The aim of this study is to describe a reduced radiation technique during lead placement for treatment with SNM. Methods: A retrospective cohort of 51 consecutive patients who underwent lead insertion and SNM placement at a single academic institution were investigated. Reduced fluoroscopy (RF; n=11) involved C-arm settings to 1 pulse/second and an activated “low-dose” setting, while conventional fluoroscopy (CF; n=40) involved 30 pulses/second and a deactivated “low-dose” setting. The automatic brightness control and collimation were used optionally in both groups. Comparison of imaging quality, fluoroscopy settings, and radiation exposure during RF and CF was performed. Results: RF settings resulted in significant reduction of radiation compared to CF settings, including the fluoroscopy time (8.61 vs. 48.16 seconds; p<0.001), dose (2.66 vs. 26.25 mGy; p=0.001), and current (1.67 vs. 4.18 mAs; p<0.001). There was no significant difference in total operative time (59.18 vs. 61.33 minutes; p=0.77) and the rate of progression from stage 1 to stage 2 during follow-up (75% vs. 84%; p=0.55). Conclusions: Lead placement for treatment with SNM can be achieved using RF settings without compromising clinical outcomes. Applying the RF technique reduces overall radiation exposure to the patient and the operating room staff. Further validation of RF in a larger prospective cohort study is needed. Level of evidence: Level 4.

Radiation exposure of the staff at the therapeutic and diagnostic nuclear medicine department

2008 ◽  
Vol 47 (04) ◽  
pp. 175-177 ◽  
Author(s):  
J. Dolezal
Keyword(s):  
Nuclear Medicine ◽  
Radiation Exposure ◽  
Effective Dose ◽  
Radiation Protection ◽  
Annual Effective Dose ◽  
Protection Measures ◽  
Professional Groups ◽  
Personal Dosimetry ◽  
The Mean ◽  
Administered Activity

SummaryAim: To assess a radiation exposure and the quality of radiation protection concerning a nuclear medicine staff at our department as a six-year retrospective study. Therapeutic radionuclides such as 131I, 153Sm, 186Re, 32P, 90Y and diagnostic ones as a 99mTc, 201Tl, 67Ga, 111In were used. Material, method: The effective dose was evaluated in the period of 2001–2006 for nuclear medicine physicians (n = 5), technologists (n = 9) and radiopharmacists (n = 2). A personnel film dosimeter and thermoluminescent ring dosimeter for measuring (1-month periods) the personal dose equivalent Hp(10) and Hp(0,07) were used by nuclear medicine workers. The wearing of dosimeters was obligatory within the framework of a nationwide service for personal dosimetry. The total administered activity of all radionuclides during these six years at our department was 17,779 GBq (99mTc 14 708 GBq, 131I 2490 GBq, others 581 GBq). The administered activity of 99mTc was similar, but the administered activity of 131I in 2006 increased by 200%, as compared with the year 2001. Results: The mean and one standard deviation (SD) of the personal annual effective dose (mSv) for nuclear medicine physicians was 1.9 ± 0.6, 1.8 ± 0.8, 1.2 ± 0.8, 1.4 ± 0.8, 1.3 ± 0.6, 0.8 ± 0.4 and for nuclear medicine technologists was 1.9 ± 0.8, 1.7 ± 1.4, 1.0 ± 1.0, 1.1 ± 1.2, 0.9 ± 0.4 and 0.7 ± 0.2 in 2001, 2002, 2003, 2004, 2005 and 2006, respectively. The mean (n = 2, estimate of SD makes little sense) of the personal annual effective dose (mSv) for radiopharmacists was 3.2, 1.8, 0.6, 1.3, 0.6 and 0.3. Although the administered activity of 131I increased, the mean personal effective dose per year decreased during the six years. Conclusion: In all three professional groups of nuclear medicine workers a decreasing radiation exposure was found, although the administered activity of 131I increased during this six-year period. Our observations suggest successful radiation protection measures at our department.

scholarly journals Attitudes and compliance with the WHO surgical safety checklist: a survey among surgeons and operating room staff in 138 hospitals in China

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Jie Tan ◽  
James Reeves Mbori Ngwayi ◽  
Zhaohan Ding ◽  
Yufa Zhou ◽  
Ming Li ◽  
...  
Keyword(s):  
Patient Safety ◽  
Adverse Events ◽  
Operating Room ◽  
World Health ◽  
Surgical Patient ◽  
Local Data ◽  
Cross Sectional ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Operating Room Staff

Abstract Background Ten years after the introduction of the Chinese Ministry of Health (MoH) version of Surgical Safety Checklist (SSC) we wished to assess the ongoing influence of the World Health Organisation (WHO) SSC by observing all three checklist components during elective surgical procedures in China, as well as survey operating room staff and surgeons more widely about the WHO SSC. Methods A questionnaire was designed to gain authentic views on the WHO SSC. We also conducted a prospective cross-sectional study at five level 3 hospitals. Local data collectors were trained to document specific item performance. Adverse events which delayed the operation were recorded as well as the individuals leading or participating in the three SSC components. Results A total of 846 operating room staff and surgeons from 138 hospitals representing every mainland province responded to the survey. There was widespread acceptance of the checklist and its value in improving patient safety. 860 operations were observed for SSC compliance. Overall compliance was 79.8%. Compliance in surgeon-dependent items of the ‘time-out’ component reduced when it was nurse-led (p < 0.0001). WHO SSC interventions which are omitted from the MoH SSC continued to be discussed over half the time. Overall adverse events rate was 2.7%. One site had near 100% compliance in association with a circulating inspection team which had power of sanction. Conclusion The WHO SSC remains a powerful tool for surgical patient safety in China. Cultural changes in nursing assertiveness and surgeon-led teamwork and checklist ownership are the key elements for improving compliance. Standardised audits are required to monitor and ensure checklist compliance.

RADIATION EXPOSURE TO THE BACK WITH DIFFERENT TYPES OF APRONS

2021 ◽  
Author(s):  
Seung Wan Hong ◽  
Tae Won Kim ◽  
Jae Hun Kim
Keyword(s):  
Radiation Exposure ◽  
Effective Dose ◽  
Exposure Time ◽  
The Other ◽  
Lead Apron ◽  
Type Group ◽  
Air Kerma ◽  
Different Types ◽  
The Relationship

Abstract Physicians and nurses stand with their back towards the C-arm fluoroscope when using the computer, taking things out of closets and preparing drugs for injection or instruments for intervention. This study was conducted to investigate the relationship between the type of lead apron and radiation exposure to the backs of physicians and nurses while using C-arm fluoroscopy. We compared radiation exposure to the back in the three groups: no lead apron (group C), front coverage type (group F) and wrap-around type (group W). The other wrap-around type apron was put on the bed instead of on a patient. We ran C-arm fluoroscopy 40 times for each measurement. We collected the air kerma (AK), exposure time (ET) and effective dose (ED) of the bedside table, upper part and lower part of apron. We measured these variables 30 times for each location. In group F, ED of the upper part was the highest (p &lt; 0.001). ED of the lower part in group C and F was higher than that in group W (p = 0.012). The radiation exposure with a front coverage type apron is higher than that of the wrap-around type and even no apron at the neck or thyroid. For reducing radiation exposure to the back of physician or nurse, the wrap-around type apron is recommended. This type of apron can reduce radiation to the back when the physician turns away from the patient or C-arm fluoroscopy.

scholarly journals Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12: Pedicle screw fixation as an adjunct to posterolateral fusion

2014 ◽  
Vol 21 (1) ◽  
pp. 75-78 ◽  
Author(s):  
Michael W. Groff ◽  
Andrew T. Dailey ◽  
Zoher Ghogawala ◽  
Daniel K. Resnick ◽  
William C. Watters ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Outcome ◽  
Pedicle Screw ◽  
Chronic Low Back Pain ◽  
Screw Fixation ◽  
Lumbar Fusion ◽  
Pedicle Screw Fixation ◽  
Controlled Study ◽  
Low Back

The utilization of pedicle screw fixation as an adjunct to posterolateral lumbar fusion (PLF) has become routine, but demonstration of a definitive benefit remains problematic. The medical evidence indicates that the addition of pedicle screw fixation to PLF increases fusion rates when assessed with dynamic radiographs. More recent evidence, since publication of the 2005 Lumbar Fusion Guidelines, suggests a stronger association between radiographic fusion and clinical outcome, although, even now, no clear correlation has been demonstrated. Although several reports suggest that clinical outcomes are improved with the addition of pedicle screw fixation, there are conflicting findings from similarly classified evidence. Furthermore, the largest contemporary, randomized, controlled study on this topic failed to demonstrate a significant clinical benefit with the use of pedicle screw fixation in patients undergoing PLF for chronic low-back pain. This absence of proof should not, however, be interpreted as proof of absence. Several limitations continue to compromise these investigations. For example, in the majority of studies the sample size is insufficient to detect small increments in clinical outcome that may be observed with pedicle screw fixation. Therefore, no definitive statement regarding the efficacy of pedicle screw fixation as a means to improve functional outcomes in patients undergoing PLF for chronic low-back pain can be made. There appears to be consistent evidence suggesting that pedicle screw fixation increases the costs and complication rate of PLF. High-risk patients, including (but not limited to) patients who smoke, patients who are undergoing revision surgery, or patients who suffer from medical conditions that may compromise fusion potential, may appreciate a greater benefit with supplemental pedicle screw fixation. It is recommended, therefore, that the use of pedicle screw fixation as a supplement to PLF be reserved for those patients in whom there is an increased risk of nonunion when treated with only PLF.

Comparative Analysis of Approaches to Regulation and Monitoring of Workers for Internal Radiation Exposure

2021 ◽  
Vol 66 (6) ◽  
pp. 102-110
Author(s):  
A. Molokanov ◽  
B. Kukhta ◽  
E. Maksimova
Keyword(s):  
Radiation Exposure ◽  
Effective Dose ◽  
Human Body ◽  
Radiation Safety ◽  
Urine Excretion ◽  
Internal Radiation ◽  
Dose Limits ◽  
Daily Urine ◽  
Permissible Levels ◽  
Committed Effective Dose

Purpose: Harmonization and improvement of the system for regulating the internal radiation exposure of workers and the basic requirements for ensuring radiation safety with international requirements and recommendations. Material and methods: Issues related to the development of approaches to regulation and monitoring of workers for internal radiation exposure in the process of evolution of the ICRP recommendations and the national radiation safety standards, are considered. The subject of analysis is the standardized values: dose limits for workers and permissible levels as well as directly related methods of monitoring of workers for internal radiation exposure, whose purpose is to determine the degree of compliance with the principles of radiation safety and regulatory requirements, including non-exceeding the basic dose limits and permissible levels. The permissible levels of inhalation intake of insoluble compounds (dioxide) of plutonium-239 are considered as a numerical example. Results: Based on the analysis of approaches to the regulation and monitoring of workers for internal radiation exposure for the period from 1959 to 2019, it is shown that a qualitative change in the approach occurred in the 1990s. It was due to a decrease in the number of standardized values by introducing a single dose limit for all types of exposure: the effective dose E, which takes into account the different sensitivity of organs and tissues for stochastic radiation effects (WT), using the previously accepted concepts of the equivalent dose H and groups of critical organs. From the analysis it follows that the committed effective dose is a linear transformation of the intake, linking these two quantities by the dose coefficient, which does not depend on the time during which the intake occurred, and reflects certain exposure conditions of the radionuclide intake (intake routes, parameters of aerosols and type of radionuclide compounds). It was also shown that the reference value of the function z(t) linking the measured value of activity in an organ (tissue) or in excretion products with the committed effective dose for a reference person, which is introduced for the first time in the publications of the ICRP OIR 2015-2019, makes it possible to standardize the method of measuring the normalized value of the effective dose. Based on the comparison of the predicted values of the lung and daily urine excretion activities following constant chronic inhalation intake of insoluble plutonium compounds at a rate equal annual limit of intake (ALI) during the period of occupational activity 50 years it was shown that the modern biokinetic models give a slightly lower level (on average 2 times) of the lungs exposure compared to the models of the previous generation and a proportionally lower level (on average 1.4 times) of plutonium urine excretion for the standard type of insoluble plutonium compounds S. However, for the specially defined insoluble plutonium compound, PuO2, the level of plutonium urine excretion differs significantly downward (on average 11.5 times) compared to the models of the previous generation. Conclusion: With the practical implementation of new ICRP OIR models, in particular for PuO2 compounds, additional studies should be carried out on the behavior of insoluble industrial plutonium compounds in the human body. Besides, additional possibilities should be used to determine the intake of plutonium by measuring in the human body the radionuclide Am-241, which is the Pu-241 daughter. To determine the plutonium urine excretion, the most sensitive measurement techniques should be used, having a decision threshold about fractions of mBq in a daily urine for S-type compounds and an order of magnitude lower for PuO2 compounds. This may require the development and implementation in monitoring practice the plutonium-DTPA Biokinetic Model.

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