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Thomas E Mroz - One of the best experts on this subject based on the ideXlab platform.
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radiation exposure to the spine surgeon in lumbar and thoracolumbar fusions with the use of an intraoperative computed tomographic 3 dimensional imaging system
Spine, 2012Co-Authors: Kalil G Abdullah, Frank S Bishop, Daniel Lubelski, Michael P Steinmetz, Edward C Benzel, Thomas E MrozAbstract:STUDY DESIGN: A prospective clinical research article. OBJECTIVE: The primary goals were to determine (1) radiation exposure to the spine surgeon with the use of an intraoperative 3-dimensional imaging system and (2) to define the safe distance from the computed tomographic scanner. SUMMARY OF BACKGROUND: Intraoperative radiation exposure to the spinal surgeon has been assessed during 2-dimensional fluoroscopy but has not been investigated during intraoperative 3-dimensional imaging. METHODS: Ten patients undergoing lumbar or thoracolumbar fusion were enrolled in a prospective trial to determine the radiation exposure to a spine surgeon standing in the substerile room, with the use of the O-ARM Imaging System (Medtronic, Memphis, TN). A thermolucent digital dosimeter was worn at chest level without a Lead Apron. Dosimeter readings and distance from the spine surgeon were recorded. RESULTS.: Average surgeon exposure was 44.22 ± 17.4 μrem (range: 17.71-70.76 μrem). The mean distance from the O-ARM was 4.56 ± .32 m, and the surgeon was exposed for an average of 19.6 ± 5.7 seconds (range: 8.05-28.7 s). The annual number of necessary procedures required to surpass the exposure limit, according to the data presented here, would be 113,071 operations using O-ARM. Hence, the number of necessary procedures for O-ARM use is predicted to be 1,130,710 annual procedures to reach the occupational exposure limits for extremity, skin, and all other organs and 339,213 procedures to reach the limits for the lens of eye. CONCLUSION: Radiation exposure is minimal to the surgical team during routine use of the O-ARM imaging system. The number of procedures required to surpass occupational exposure limits is high if using appropriate distance from the O-ARM.
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radiation exposure to the surgeon and the patient during kyphoplasty
Journal of Spinal Disorders & Techniques, 2008Co-Authors: Thomas E Mroz, William J Davros, Takayuki Yamashita, Isador H LiebermanAbstract:STUDY DESIGN: Prospective study of patients who underwent single or multilevel kyphoplasty for vertebral fractures. OBJECTIVE: To quantify the radiation exposure to the surgeon and to the patient during kyphoplasty, and also to provide a procedural algorithm that effectively minimizes the radiation exposure to the surgeon during any fluoroscopic-guided procedure. SUMMARY OF BACKGROUND DATA: Spine surgeons who perform minimally invasive procedures often employ fluoroscopy for intraoperative navigation. METHODS: Twenty-seven patients were enrolled. Two fluoroscopes (1 anterior/posterior and 1 lateral) were used for localization, navigation, and monitoring cement flow. All surgeons wore thyroid shields and Lead Aprons. The dose of radiation exposure was measured by dosimeter badges. One badge was attached to each patient. The surgeons wore 3 badges: under the thyroid shield (protected), under the Lead Apron over the left chest (protected), and outside the Lead Apron over the left chest (unprotected). A thermoluminescent ring dosimeter was worn on the right hand for 18 cases, and on the left hand for 9 cases. RESULTS: The exposure time was 5.7+/-2.0 minutes/vertebra for a single level (n=10), 3.9+/-0.8 minutes/vertebra for a 2 level (n=9), 2.9+/-1.2 minutes/vertebra for a 3 level kypholasty (n=8). The exposure time of single level kyphoplasy was significantly different from that of multilevel kyphoplasy (2 level, P=0.040; 3 level, P=0.002). Surgeon exposure as measured by the protected dosimeter was less than the minimum reportable dose (<0.010 mSv). Exposure as measured by the unprotected dosimeter, which is equivalent to deep whole body exposure was 0.248+/-0.170 mSv/vertebra. The eye exposure was 0.271+/-0.200 mSv/vertebra, and the shallow exposure (hand/skin) was 0.273+/-0.200 mSv/vertebra. The hand exposure was 1.744+/-1.173 mSv/vertebra. CONCLUSIONS: Without eye or hand protection, the total radiation exposure dose to these areas would exceed the occupational exposure limit after 300 cases per year. Surgeons should wear Lead lined glasses and keep their hands out of the radiation beam.
Kalil G Abdullah - One of the best experts on this subject based on the ideXlab platform.
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radiation exposure to the spine surgeon in lumbar and thoracolumbar fusions with the use of an intraoperative computed tomographic 3 dimensional imaging system
Spine, 2012Co-Authors: Kalil G Abdullah, Frank S Bishop, Daniel Lubelski, Michael P Steinmetz, Edward C Benzel, Thomas E MrozAbstract:STUDY DESIGN: A prospective clinical research article. OBJECTIVE: The primary goals were to determine (1) radiation exposure to the spine surgeon with the use of an intraoperative 3-dimensional imaging system and (2) to define the safe distance from the computed tomographic scanner. SUMMARY OF BACKGROUND: Intraoperative radiation exposure to the spinal surgeon has been assessed during 2-dimensional fluoroscopy but has not been investigated during intraoperative 3-dimensional imaging. METHODS: Ten patients undergoing lumbar or thoracolumbar fusion were enrolled in a prospective trial to determine the radiation exposure to a spine surgeon standing in the substerile room, with the use of the O-ARM Imaging System (Medtronic, Memphis, TN). A thermolucent digital dosimeter was worn at chest level without a Lead Apron. Dosimeter readings and distance from the spine surgeon were recorded. RESULTS.: Average surgeon exposure was 44.22 ± 17.4 μrem (range: 17.71-70.76 μrem). The mean distance from the O-ARM was 4.56 ± .32 m, and the surgeon was exposed for an average of 19.6 ± 5.7 seconds (range: 8.05-28.7 s). The annual number of necessary procedures required to surpass the exposure limit, according to the data presented here, would be 113,071 operations using O-ARM. Hence, the number of necessary procedures for O-ARM use is predicted to be 1,130,710 annual procedures to reach the occupational exposure limits for extremity, skin, and all other organs and 339,213 procedures to reach the limits for the lens of eye. CONCLUSION: Radiation exposure is minimal to the surgical team during routine use of the O-ARM imaging system. The number of procedures required to surpass occupational exposure limits is high if using appropriate distance from the O-ARM.
Krzysztof Młynarczyk - One of the best experts on this subject based on the ideXlab platform.
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feasibility of implementation of a simplified no x ray no Lead Apron two catheter approach for ablation of supraventricular arrhythmias in children and adults
Journal of Cardiovascular Electrophysiology, 2014Co-Authors: Sebastian Stec, Mariusz Mazij, Małgorzata Raś, Bartosz Ludwik, Michał Chrabąszcz, Małgorzata Banasik, Magdalena Bzymek, Janusz śledź, Arkadiusz śledź, Krzysztof MłynarczykAbstract:Simplified, No-X-Ray Catheter Ablation of SVT Introduction Although the “near-zero-X-Ray” or “No-X-Ray” catheter ablation (CA) approach has been reported for treatment of various arrhythmias, few prospective studies have strictly used “No-X-Ray,” simplified 2-catheter approaches for CA in patients with supraventricular tachycardia (SVT). We assessed the feasibility of a minimally invasive, nonfluoroscopic (MINI) CA approach in such patients. Methods Data were obtained from a prospective multicenter CA registry of patients with regular SVTs. After femoral access, 2 catheters were used to create simple, 3D electroanatomic maps and to perform electrophysiologic studies. Medical staff did not use Lead Aprons after the first 10 MINI CA cases. Results A total of 188 patients (age, 45 ± 21 years; 17% 0.05), major complications (0% vs. 0%, P > 0.05) and acute (98% vs. 98%, P > 0.05) and long-term (93% vs. 94%, P > 0.05) success rates were similar in the “No-X-Ray” and control groups. Conclusions Implementation of a strict “No-X-Ray, simplified 2-catheter” CA approach is safe and effective in majority of the patients with SVT. This modified approach for SVTs should be prospectively validated in a multicenter study.
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Feasibility of Implementation of a “Simplified, No‐X‐Ray, No‐Lead Apron, Two‐Catheter Approach” for Ablation of Supraventricular Arrhythmias in Children and Adults
Journal of Cardiovascular Electrophysiology, 2014Co-Authors: Sebastian Stec, Janusz Śledź, Mariusz Mazij, Małgorzata Raś, Bartosz Ludwik, Michał Chrabąszcz, Arkadiusz Śledź, Małgorzata Banasik, Magdalena Bzymek, Krzysztof MłynarczykAbstract:Simplified, No-X-Ray Catheter Ablation of SVT Introduction Although the “near-zero-X-Ray” or “No-X-Ray” catheter ablation (CA) approach has been reported for treatment of various arrhythmias, few prospective studies have strictly used “No-X-Ray,” simplified 2-catheter approaches for CA in patients with supraventricular tachycardia (SVT). We assessed the feasibility of a minimally invasive, nonfluoroscopic (MINI) CA approach in such patients. Methods Data were obtained from a prospective multicenter CA registry of patients with regular SVTs. After femoral access, 2 catheters were used to create simple, 3D electroanatomic maps and to perform electrophysiologic studies. Medical staff did not use Lead Aprons after the first 10 MINI CA cases. Results A total of 188 patients (age, 45 ± 21 years; 17% 0.05), major complications (0% vs. 0%, P > 0.05) and acute (98% vs. 98%, P > 0.05) and long-term (93% vs. 94%, P > 0.05) success rates were similar in the “No-X-Ray” and control groups. Conclusions Implementation of a strict “No-X-Ray, simplified 2-catheter” CA approach is safe and effective in majority of the patients with SVT. This modified approach for SVTs should be prospectively validated in a multicenter study.
Chet R. Rees - One of the best experts on this subject based on the ideXlab platform.
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Oxford Medicine Online - Reducing Operator Exposure Using Suspended Radiation Protection System
Oxford Medicine Online, 2018Co-Authors: Almas Syed, Robert Evans Heithaus, Chet R. ReesAbstract:The increasing utilization of radiation for diagnostic and therapeutic procedures has provided impetus for improved strategies of radiation protection for interventionalists. The associated discomfort, disability, and career-shortening effects of Lead Aprons for heavy fluoroscopy users have served as an impetus for the development of lighter and more comfortable models. A suspended radiation protection system employs the use of a “weightless” shield resembling a thick large Lead Apron with head shield and arm shields. The shield moves with the operator like a garment, providing extensive protection without orthopedic strain or discomfort while maintaining full user functionality. Utilization of a suspended radiation protection system provides the operator with optimum radiation protection, without any additional weight, and maintains procedural flexibility.
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Evaluation of a Suspended Personal Radiation Protection System vs. Conventional Apron and Shields in Clinical Interventional Procedures
Open Journal of Radiology, 2013Co-Authors: Clare Savage, Daniel A. Marichal, Thomas M. Seale, Cathryn J. Shaw, Bruner P. Angela, Chet R. ReesAbstract:Purpose: This clinical study compares conventional Lead Aprons and ancillary shields to a functionally weightless personal overhead-supported system with expanded coverage. Materials and Methods: Primary operators performed procedures (N = 126, fluoroscopy minutes = 1209) using one of 2 methods of radiation protection and wearing dosimeters on multiple body locations. Method “LAS” (Lead-Apron+Shields): Lead skirt, vest, thyroid shield, with 100% use of under-table shield, side shield, and mobile suspended Lead-acrylic shield. Method “Zgrav”: ZeroGravity system (CFI Medical Solutions) with variable use of shielding. The studied early model moving with the operator had a curved Lead-acrylic head shield (0.5 mm Pb) and expansive Lead Apron (0.5 - 1.0 mm Pb) that covered leg to distal calf and proximal arm to elbow, and a drape that permitted sterile entry and exit. Study was institutional review board approved and HIPPA-compliant. Results: Measured with a sensitive electronic dosimeter, eye exposures were 99% (P < 0.001) reduced for Zgrav with upgraded face shield vs. LAS, regardless of use or non-use of suspended shield with Zgrav. With optically stimulated luminescence (OSL) dosimeters, operator exposures, standardized to minutes of fluoroscopy and Fluoroscopic Patient Dose Area Product, were reduced by 87% - 100% for eye & head, neck, humerus, and tibia (Zgrav vs. LAS). Overall eye & head exposure reduction for entire study was 94%. Non-equivalence of torso exposures was not demonstrated. A brief user survey showed ergonomic advantages of Zgrav. Conclusion: Compared to conventional Lead Aprons with shields, the suspended system provided superior operator protection during interventional fluoroscopy, allowing operators to perform procedures without potentially obstructive shields.
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Comparison of a Suspended Radiation Protection System versus Standard Lead Apron for Radiation Exposure of a Simulated Interventionalist
Journal of Vascular and Interventional Radiology, 2011Co-Authors: Daniel A. Marichal, Temoor Anwar, David Kirsch, Jessica Clements, Luke A. Carlson, Clare Savage, Chet R. ReesAbstract:Abstract Purpose To evaluate the radiation protective characteristics of a system designed to enhance operator protection while eliminating weight to the body and allowing freedom of motion. Materials and Methods Radiation doses to a mock interventionalist were measured with calibrated dosimeters in a clinical interventional suite. A standard Lead Apron (SLA; Pb equivalent, 0.5 mm) was compared with a suspended radiation protection system (ZeroGravity; Zgrav) that shields from the top of the head to the calves (except the right arm and left forearm) with a complex overhead motion system that eliminates weight on the operator and allows freedom of motion. Zgrav included a suspended Lead Apron with increased Lead equivalency, greater length, proximal left arm and shoulder coverage, and a wraparound face shield of 0.5 mm Pb equivalency. A 26-cm-thick Lucite stack (ie, mock patient) created scatter during 10 controlled angiography sequences of 120 exposures each. Parameters included a field of view of 40 cm, table height of 94 cm, 124 cm from the tube to image intensifier, 50 cm from the image center to operator, 66 kVp, and 466–470 mA. Results Under identical conditions, average doses (SLA vs Zgrav) were 264 versus 3.4 (ratio, 78) to left axilla ( P P P P Conclusions Relative to a conventional Lead Apron, the Zgrav system provided a 16–78-fold decrease in radiation exposure for a mock interventionalist in a simulated clinical setting.
J. M. Viera - One of the best experts on this subject based on the ideXlab platform.
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Radiation dose in vertebroplasty
Neuroradiology, 2004Co-Authors: A. Mehdizade, K. O. Lovblad, K. E. Wilhelm, T. Somon, S. G. Wetzel, A. D. Kelekis, H. Yilmaz, G. Abdo, J. B. Martin, J. M. VieraAbstract:We wished to measure the absorbed radiation dose during fluoroscopically controlled vertebroplasty and to assess the possibility of deterministic radiation effects to the operator. The dose was measured in 11 consecutive procedures using thermoluminescent ring dosimeters on the hand of the operator and electronic dosimeters inside and outside of the operator’s Lead Apron. We found doses of 0.022–3.256 mGy outside and 0.01–0.47 mGy inside the Lead Apron. Doses on the hand were higher, 0.5–8.5 mGy. This preliminary study indicates greater exposure to the operator’s hands than expected from traditional Apron measurements.