Radiation Exposure To The Physician During X-Ray Intensive Spine Procedures Is Directly Related To Patient Dose

Presented at SMISS Annual Forum 2014
By Cary Idler MD
With Robert E. Isaacs MD, Jordan Swearingen BS, Sarah Byrd MSN, ANP-BC,

Disclosures: Cary Idler MD B; Nuvasive, Inc., Corelink Robert Isaacs MD A; NuVasive. B; NuVasive, Providence Medical Technology. C; Association for Collaborative Spine Research. D; SafeRay Spine, LLC, SafeWire, LLC, VilaSpine LTD, Vertera Spine, Providence Medical Technol, Jordan Swearingen BS None, Sarah Byrd MSN, ANP-BC None,

Introduction:
Radiation exposure during x-ray intensive medical procedures is a potential health threat to physicians, staff, and patients alike. While the patient is exposed only at the time of their procedure, physicians, assistants, and scrub nurses are bombarded with scatter radiation during each intervention throughout their career. While the ionizing radiation exposure to the patient is easily found, as it is recorded and displayed on the fluoroscope screen throughout the intervention, the amount of exposure that the physician is subjected to cannot so easily be recognized.

Aims/Objectives:
Herein we compare the patient radiation exposure to the physician’s during x-ray intensive medical procedures and determine if it is possible to extrapolate our exposure from that of the patient.

Methods:
The senior physician wore a digital dosimeter during an 11-month period whenever he performed a minimally invasive spine fusion. The patient demographic information, the procedure, number of screws, radiation exposure during various parts of the procedure (set-up, anterior approach, screw placement, etc.) were recorded in a radiation database. The physician practiced the principals of ALARA, including pulse and low dose imaging and stepping away, whenever the procedure allowed. Data analysis was performed in Matlab.

Results:
During a 12 month period, 59 minimally invasive spine fusions were performed. In total, 376 percutaneous pedicle screws were placed, with an average radiation dose to the patient of 0.50 mRem per screw. The amount of radiation, though, was heavily dependent on whether or not the physician was able to accept the image quality of low radiation imaging (which provided 48% less patient radiation exposure per screw, p<0.001). The physician’s radiation exposure was noted to have a linear relationship to that of the patient, with 2/3rds (66.2%) of the variance being determined by this one factor alone.

Conclusions:
There is a linear relationship between radiation exposure to the physician and that of the patient, with 66% of the variance being determined by this one factor alone.