Radiation exposure to the eyes and thyroid during C-arm fluoroscopy-guided cervical epidural injections is far below the safety limit
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Background: The aim of this study was to evaluate radiation exposure to the eye and thyroid in pain physicians during the fluoroscopy-guided cervical epidural block (CEB). Methods: Two pain physicians (a fellow and a professor) who regularly performed Carm fluoroscopy-guided CEBs were included. Seven dosimeters were used to measure radiation exposure, five of which were placed on the physician (forehead, inside and outside of the thyroid protector, and inside and outside of the lead apron) and two were used as controls. Patient age, sex, height, and weight were noted, as were radiation exposure time, absorbed radiation dose, and distance from the X-ray field center to the physician. Results: One hundred CEB procedures using C-arm fluoroscopy were performed on comparable patients. Only the distance from the X-ray field center to the physician was significantly different between the two physicians (fellow: 37.5 ± 2.1 cm, professor: 41.2 ± 3.6 cm, P = 0.03). The use of lead-based protection effectively decreased the absorbed radiation dose by up to 35%. Conclusions: Although there was no difference in radiation exposure between the professor and the fellow, there was a difference in the distance from the X-ray field during the CEBs. Further, radiation exposure can be minimized if proper protection (thyroid protector, leaded apron, and eyewear) is used, even if the distance between the X-ray beam and the pain physician is small. Damage from frequent, low-dose radiation exposure is not yet fully understood. Therefore, safety measures, including lead-based protection, should always be enforced.
Abstract
Background: The aim of this study was to evaluate radiation exposure to the eye and thyroid in pain physicians during the fluoroscopy-guided cervical epidural block (CEB). Methods: Two pain physicians (a fellow and a professor) who regularly performed Carm fluoroscopy-guided CEBs were included. Seven dosimeters were used to measure radiation exposure, five of which were placed on the physician (forehead, inside and outside of the thyroid protector, and inside and outside of the lead apron) and two were used as controls. Patient age, sex, height, and weight were noted, as were radiation exposure time, absorbed radiation dose, and distance from the X-ray field center to the physician. Results: One hundred CEB procedures using C-arm fluoroscopy were performed on comparable patients. Only the distance from the X-ray field center to the physician was significantly different between the two physicians (fellow: 37.5 ± 2.1 cm, professor: 41.2 ± 3.6 cm, P = 0.03). The use of lead-based protection effectively decreased the absorbed radiation dose by up to 35%. Conclusions: Although there was no difference in radiation exposure between the professor and the fellow, there was a difference in the distance from the X-ray field during the CEBs. Further, radiation exposure can be minimized if proper protection (thyroid protector, leaded apron, and eyewear) is used, even if the distance between the X-ray beam and the pain physician is small. Damage from frequent, low-dose radiation exposure is not yet fully understood. Therefore, safety measures, including lead-based protection, should always be enforced.
참고문헌 (36)
- Manchikanti L, "Saga of payment systems of ambulatory surgery centers for interventional techniques : an update", Pain Physician, 15, pp.109~130 (2012)
- Vera GV, "Assessment of genome damage in occupational exposure to ionising radiation and ultrasound", Mutat Res, 395, pp.101~105 (1997)
- Andreassi MG, "The biological effects of diagnostic cardiac imaging on chronically exposed physicians : the importance of being non-ionizing", Cardiovasc Ultrasound, 2, pp.25~ (2004)
- Maffei F, "Spectrum of chromosomal aberrations in peripheral lymphocytes of hospital workers occupationally exposed to low doses of ionizing radiation", Mutat Res, 547, pp.91~99 (2004)
- Krempen JF, "Nerve-root injection : a method for evaluating the etiology of sciatica", J Bone Joint Surg Am, 56, pp.1435~1444 (1974)
- White AH, "Injection techniques for the diagnosis and treatment of low back pain", Orthop Clin North Am, 14, pp.553~567 (1983)
- Bicket MC, "Epidural injections for spinal pain : a systematic review and metaanalysis evaluating the"control"injections in randomized controlled trials", Anesthesiology, 119, pp.907~931 (2013)
- Candido KD, "Cervical epidural steroid injections for the treatment of cervical spinal(neck)pain", Curr Pain Headache Rep, 17, pp.314~ (2013)
- Bose B, "Quadriparesis following cervical epidural steroid injections : case report and review of the literature", Spine J, 5, pp.558~563 (2005)
- Hodges SD, "Cervical epidural steroid injection with intrinsic spinal cord damage. Two case reports", Spine (Phila Pa 1976), 23, pp.2137~2142 (1998)
- Khan S, "Cervical epidural injection complicated by syrinx formation: a case report", Spine (Phila Pa 1976), 35, pp.E614~616 (2010)
- Nakashima E, "A reanalysis of atomic-bomb cataract data, 2000-2002 : a threshold analysis", Health Phys, 90, pp.154~160 (2006)
- Neriishi K, "Postoperative cataract cases among atomic bomb survivors : radiation dose response and threshold", Radiat Res, 168, pp.404~408 (2007)
- Vano E, "Radiation exposure to cardiologists : how it could be reduced", Heart, 89, pp.1123~1124 (2003)
- Ciraj-Bjelac O, "Risk for radiation-induced cataract for staff in interventional cardiology: is there reason for concern?", Catheter Cardiovasc Interv, 76, pp.826~834 (2010)
- Vano E, "Radiation cataract risk in interventional cardiology personnel", Radiat Res, 174, pp.490~495 (2010)
- Chodick G, "Risk of cataract after exposure to low doses of ionizing radiation : a 20-year prospective cohort study among US radiologic technologists", Am J Epidemiol, 168, pp.620~631 (2008)
- Rehani MM, "Radiation and cataract", Radiat Prot Dosimetry, 147, pp.300~304 (2011)
- Stewart FA, "ICRP publication 118 : ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs--threshold doses for tissue reactions in a radiation protection context", Ann ICRP, 41, pp.1~322 (2012)
- "The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103", Ann ICRP, 37, pp.1~332 (2007)
- Manchikanti L, "Radiation exposure to the physician in interventional pain management", Pain Physician, 5, pp.385~393 (2002)
- 정철희, "Radiation Exposure of the Hand and Chest during C-arm Fluoroscopy-Guided Procedures", The Korean Journal of Pain, 26(1), pp.51~56 (2013), 대한통증학회
- Botwin KP, "Radiation exposure to the physician performing fluoroscopically guided caudal epidural steroid injections", Pain Physician, 4, pp.343~348 (2001)
- Botwin KP, "Radiation exposure to the spinal interventionalist performing lumbar discography", Pain Physician, 6, pp.295~300 (2003)
- Botwin KP, "Radiation exposure of the spinal interventionalist performing fluoroscopically guided lumbar transforaminal epidural steroid injections", Arch Phys Med Rehabil, 83, pp.697~701 (2002)
- Politi L, "Reduction of scatter radiation during transradial percutaneous coronary angiography : a randomized trial using a lead-free radiation shield", Catheter Cardiovasc Interv, 79, pp.97~102 (2012)
- Paulson EK, "CT fluoroscopy--guided interventional procedures : techniques and radiation dose to radiologists", Radiology, 220, pp.161~167 (2001)
- Singer G, "Occupational radiation exposure to the surgeon", J Am Acad Orthop Surg, 13, pp.69~76 (2005)
- Richman AH, "Effectiveness of lead lenses in reducing radiation exposure", Radiology, 121, pp.357~359 (1976)
- Oyar O, "How protective are the lead aprons we use against ionizing radiation?", Diagn Interv Radiol, 18, pp.147~152 (2012)
- Bordoli SJ, "Radiation safety education in vascular surgery training", J Vasc Surg, 59, pp.860~864 (2014)
- Friedman AA, "Radiation safety knowledge and practices among urology residents and fellows : results of a nationwide survey", J Surg Educ, 70, pp.224~231 (2013)
- 천보경, "Radiation safety: a focus on lead aprons and thyroid shields in interventional pain management", The Korean Journal of Pain, 31(4), pp.244~252 (2018), 대한통증학회
- Pyong Eun Park, "Radiation Safety and Education in the Applicants of the Final Test for the Expert of Pain Medicine", The Korean Journal of Pain, 25(1), pp.16~21 (2012), 대한통증학회
- Zhou Y, "Fluoroscopy radiation safety for spine interventional pain procedures in university teaching hospitals", Pain Physician, 8, pp.49~53 (2005)
- Cousin AJ, "The case for radioprotective eyewear", facewear. Practical implications and suggestions, 1987, pp.22, 688~692