Measuring Real Time Radiation Exposure to Spine Focused Neurosurgeons

INTRODUCTION: C-arm fluoroscopy and O-arm navigation are vital tools in modern spine surgeries, but their repeated usage can endanger spine surgeons. While a surgeon’s chest and abdomen are protected by lead aprons, the eyes and extremities generally receive less protection. METHODS: This prospective cohort study includes 65 consecutive spine surgeries performed by a single spine-focused neurosurgeon over a 9-month period. Radiation exposure to the primary surgeon was measured through dosimeters worn over the lead apron, under the lead apron, on surgical loupes, and as a ring on the dominant hand. Differences were assessed with rigorous statistical testing and radiation exposure per surgical case was extrapolated. RESULTS: During the study, the measured radiation exposure over the apron, 176 mrem, was significantly greater than that under the apron, 8 mrem (p = .0020), demonstrating shielding’s protective effect. The surgeon’s dominant hand was exposed to 329 mrem while the eyes were exposed to 152.5 mrem of radiation. Compared to the surgeon’s protected abdominal area, the hands (p = .0002) and eyes (p=.0002) received significantly greater exposure. Calculated exposure per case was 2.8 mrem for the eyes and 5.1 mrem for the hands. It was determined that a spine-focused neurosurgeon operating 400 cases annually will incur a radiation exposure of 60,750 mrem to the hands and 33,900 mrem to the eyes over a 30-year career. CONCLUSIONS: Our study found that spine surgeons encounter significantly more radiation exposure to the eyes and the extremities compared to protected body regions. Lifetime exposure exceeds the annual limits set by the International Commission on Radiological Protection for the extremities (50,000 mrem/yr) and the eyes (15,000 mrem/yr), calling for increased awareness about the dangerous levels of radiation exposure that a spine surgeon incurs over one’s career.