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Médecine du travail du personnel hospitalier

Types and Arrangement of Thyroid Shields to Reduce Exposure of Surgeons to Ionizing Radiation During Intraoperative Use of C-arm Fluoroscopy

Auteur Seung Yeol Lee
Auteur Eungi Min
Auteur Jaekeon Bae
Auteur Chin Youb Chung
Auteur Kyoung Min Lee
Auteur Soon-Sun Kwon
Auteur Moon Seok Park
Auteur Kisung Lee
Publication Spine
Date Aug 16, 2013
Résumé Study Design. Measurement of radiation dose from C-arm fluoroscopy during a simulated intraoperative use in spine surgery.Objective. To assess how the radiation dose is affected by changes in the types of thyroid shields used, and by the arrangements in which they are worn during the intraoperative use of C-arm fluoroscopy.Summary of Background Data. Even though the danger to the thyroid from exposure to radiation is well-known, there are no guidelines for the proper use of thyroid shields.Methods. Two photo-luminescence dosimeters were used to measure the dose of scatter radiation arriving at the location of the thyroid in a whole body phantom, in the position of the surgeon. On an operating table beside this set-up, was an anthropomorphic chest-phantom representing a patient, for which treatment with C-arm fluoroscopy was simulated. Radiation doses were measured using three different arrangements of the thyroid shield: worn tightly, worn loosely, and worn loosely with a bismuth masking reagent. Same tests were performed using two kinds of thyroid shield: lead and lead-equivalent.Results. For the lead shield group, radiation doses were measured in three arrangements; worn tightly, worn loosely, and worn loosely with bismuth masking reagent, for which the results were 1.91±0.13, 2.35±0.22, and 1.86±0.13 μSv/min, respectively. Wearing the shield tight against the throat, and wearing it loose with a bismuth masking reagent, led to lower radiation exposure levels than simply wearing the shield loosely (p≤0.001). For the lead-equivalent shield group, doses were measured for the same three arrangements, for which the results were 1.79±0.12, 1.82±0.11, and 1.74±0.12 μSv/min. Lower scatter radiation doses were delivered to the thyroid in the lead-equivalent thyroid shield group as compared to the lead thyroid shield group (p≤0.001). The unshielded thyroid group received a radiation dose of 16.32±0.48 μSv/min.Conclusion. The use of some form of thyroid shield is essential during treatment with C-arm fluoroscopy. It was found that the best ways to reduce scatter radiation exposure to the thyroid were wearing the thyroid shield tightly or wearing it loosely in combination with a bismuth masking reagent.

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