X-ray Protection Research Of The Lumber Minimally Invasive Percutaneous Internal Fixation And Endoscopic Discectomy Surgery

Part I Radiation exposure in the surgery of minimally invasivepercutaneous internal fixationObjective To compare the radiation dose and fluorescence times in the minimallyinvasive percutaneous internal fixation with or without the epidermal locator and theintradermal locator and to investigate the radiation protection during the surgery. MethodMinimally invasive percutaneous decompression and internal fixation under theexpandable channel was performed in20cases (male:9; female:11) from2012.1to2012.6.Patients’ mean age was66yrs (range48-78yrs) and all of them had single-level lumbar discherniation combined with instability (2cases at L3-4;10cases at L4-5;8cases at L5-S1).Discectomy, decompression, interbody fusion and pedicle screw fixation was performed atthe targeted level by one surgeon. Epidermal and intradermal locator were used in10casesof group A while fluorescence was performed regularly without any kind of locator in10cases of group B. G-arm fluorescence machine was used in the surgery. Radiation exposuredose data was collected from six sites of the surgeon’s body (right hand finger, rightforearm, eyes, thyroid gland, left chest and gonadal gland). Radiation dose andfluorescence times of the two groups were recorded. Result All surgeries were performedsuccessfully. The whole average operation time was150.5min (range121-193min) andfluorescence time was59sec (range38-82s). In group A the average operation time andfluorescence time were141.2min (range121-172min) and49.6sec separately and in groupB the results were159.8min (range132-193min) and68.4sec. The anterior to posterior direction exposure tube voltage of the G-arm machine was70-80kV, the tube current was2.0-3.0mA while for the left to right direction, the data was95-110kV and3.0-4.0mA.Conclusion Epidermal and intradermal locator could significantly reduce the fluorescencetimes and operation time in minimally invasive percutaneous internal fixation, so it couldhelp to reduce the whole radiation exposure in the surgery. PartⅡ Radiation Research to the Surgeon During PercutaneousTransforaminal Dndoscopic Lumbar DiscectomyObjective The purpose of this study was to measure the radiation dose to which thesurgeons are exposed during each percutaneous endoscopic lumbar discectomy (PELD)and to calculate the allowable number of cases per year. Methods A retrospective studywas carried on successive21patients who underwent percutaneous endoscopic lumbardiscectomy (PELD) for lumbar disc herniation from February2012to May2012.9malesand12females were admitted with mean age of38years (range,24-76years). The lumbar4-5disc herniation in18cases,L5-S1intervertebral disc hernia in3cases,and they aresingle-segment disc herniation. With only one surgeon operating standard percutaneoustransforaminal endoscopic discectomy, the radiation exposure of the right hand,forearm,eye, neck, chest, and perineum of the surgeon was measured during operation.And byreferring to "the International Commission on Radiological Protection (ICRP)" for healthcare workers received radiation doses of standard limits to calculate allowing the numberof surgical operations a doctor per year. Results During operation,the mean operation timewas48.9minutes, and the mean fluoroscopy time was0.43minutes, No significantcorrelations were found between operation time and fluoroscopy time. The calculatedmean effective radiation dose each operationunprotected were as follows: right forearm0.1133mSv, right hand0.3468mSv, eye0.0204mSv, thyroid0.0413mSv, left chest0.0861mSv, gonadal0.0814mSv. The left chest and thyroid, eye protective effects of a lead collar,lead apron and lead mask were demonstrated by the reduction of the radiation doseby84.7%、88.4%、89.2%, respectively. Therefore, with regard to whole-body radiation,3817operations can be performed per year using a lead apron, whereas only581operations can be performed without using a lead apron, Moreover,7352operations can beperformed within the occupational exposure limit for the eyes (150mSv), and1441operations can be performed within the occupational exposure limit for the hands (500mSv) veery years. Conclusion Without radiation shielding, a surgeon performing581PELDs annually would be exposed to the maximum allowable radiation dose. Given themeasurable lifetime X-ray radiation hazards to the surgeon, the use of adequate protectiveequipment is essential to reducing exposure during PELD.