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Occupational Radiation Exposure for a Spinal Interventionalist Performing Fluoroscopic Selective Nerve Root Block: A
Daiki Nakajima1, Kazuta Yamashita1, Yasuyuki Omichi1
1Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
Introduction:
Awareness of the harmful effects of long-term low-dose radiation is increasing. There are few comprehensive reports that accurately evaluate the radiation exposure dose to spinal interventionalists during selective nerve root block (SNRB). The purpose of this study was to evaluate the radiation exposure doses from C-arm fluoroscopy to different body areas of the interventionalist and to assess the effectiveness of lead-equivalent protective gear in reducing radiation exposure during SNRB.
Methods:
Seven fresh cadavers were irradiated for 1 and 3 minutes using C-arm fluoroscopy to stimulate the real clinical setting of SNRB. The X-ray source was positioned both under and over the table. Radiation exposure doses were measured using real-time dosimeters. Lead-equivalent protective gear was placed on each body part (crystalline lens, thyroid gland, chest, non-dominant hand, dominant hand, gonads, and foot).
Results:
Scatter radiation exposure doses to the upper body of the interventionalist were much higher when the X-ray source was positioned over the table compared to when it was positioned under the table. Use of X-ray protective gear reduced radiation exposure to the interventionalist regardless of the X-ray source position. The direct radiation dose to the hand in the irradiated field was extremely high when the X-ray source was positioned over the table-approximately 85 times higher than when under the table. Notably, hand doses remained extremely high even when the interventionalist wore protective gloves, although X-ray-protective-gear reduced overall radiation exposure.
Conclusions:
This is the first report to quantify both scattered and direct radiation doses to each body part, as well as the reduction effect of using X-ray protective gear, in detail using fresh cadavers instead of patients. Spinal interventionalists should preferentially use an under-table X-ray source during SNRB and should consistently wear adequate X-ray-protective gear to minimize occupational radiation exposure.
