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Radiation Dose to the Neurosurgeon During Invasive Back Pain Management Procedures

van der Merwe, Belinda M Tech; Friedrich-Nel, Hesta PhD

doi: 10.1097/WNQ.0b013e3181a362a9
Original Articles
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The aim of the study was to determine radiation dose levels around the theater table, on either side of the C-arm, to establish whether the radiation dose received by staff during back pain procedures fell within the limits set by the International Commission of Radiological Protection. To apply the as low as reasonably achievable (ALARA) principle, the possibility of lowering the radiation dose in the neurologic theater was explored. The measurement methodology of the study was two-fold: measurements were executed by means of thermoluminescent detectors (TLDs), and also with an ionization chamber. TLD meters were placed on the patient, the neurosurgeon and the radiographer during back pain procedure fluoroscopy, to record the doses with the image intensifier (II) above the table and also with the x-ray tube above the table, at the pelvis and the chest height of the staff. Ionization chamber measurements were recorded in 25 cm intervals around the theater table with a phantom and the C-arm positioned in the posterior-anterior, oblique and lateral positions at 110 and 133 cm heights from the floor. The TLD results indicated that, when compared to the II side, the radiation dose was higher on the x-ray tube side of the C-arm. Radiation dose levels with the x-ray tube above the table during back pain management procedures in the current theater exceeded the occupational annual recommendation of 500 mSv to the neurosurgeon's hands, as recommended by the International Commission of Radiological Protection. The opposite is true with the II positioned above the table. The potential higher doses on the x-ray tube side were confirmed by the ionization chamber measurements. Application of the ALARA principle grounds the placement of the neurosurgeon in relation to the II side of the C-arm and is a matter of meticulous thought and planning. The measurement values resulted in a proposed protocol in terms of positioning of staff and orientation of the C-arm to apply the ALARA principle during back pain procedures.

Radiographer-Sole Private Practice, Bloemfontein, South Africa

Funding: Central University of Technology, Free State, Bloemfontein.

Reprints: Belinda van der Merwe, M Tech, Magister Technologiae Radiography, P.O. Box 26719, Langenhovenpark 9330, South Africa (e-mail: belinda@mmtrain.co.za).

© 2009 Lippincott Williams & Wilkins, Inc.