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Radiation Exposure During Pedicle Screw Placement in Adolescent Idiopathic Scoliosis: Is Fluoroscopy Safe?

Ul Haque, Maahir BA; Shufflebarger, Harry L. MD*; O’Brien, Michael MD*; Macagno, Angel MD*

doi: 10.1097/01.brs.0000238675.91612.2f

Study Design. With institutional review board approval, prospective data were collected during fluoroscopically guided pedicle screw placement.

Objective. To estimate a surgeon’s radiation exposure with all screw constructs during surgery to repair idiopathic scoliosis.

Summary of Background Data. To our knowledge, there is no established consensus regarding the safety of radiation exposure during fluoroscopically guided procedures.

Methods. A surgeon was outfitted intraoperatively with a thermoluminescent dosimeter to estimate radiation exposure to his whole body and thyroid gland.

Results. The index surgeon is projected to receive 13.49 mSv of whole body ionizing radiation and 4.31 mSv of thyroid gland irradiation annually. The National Council on Radiation Protection’s current recommendations set lifetime dose equivalent limits for classified workers (radiologists) at 10 mSv per year of life and at 3 mSv for nonclassified workers (spinal surgeons). At the levels estimated, a surgeon beginning his/her career at age 30 years would exceed the lifetime limit for nonclassified workers in less than 10 years. The National Council on Radiation Protection limits the single-year maximum safe dosage to the thyroid to 500 mSv; the yearly exposure estimated here is significantly less.

Conclusions. The spinal surgeon’s intraoperative radiation exposure may be unacceptable. Spinal surgeons should be considered classified workers and monitored accordingly. Methods to lower radiation dosage seem strongly indicated.

Spinal surgeons are exposed to ionizing radiation while performing fluoroscopically guided procedures. This study monitors the total body and thyroid exposure of a pediatric spinal surgeon during surgical correction of adolescent idiopathic scoliosis and finds that the levels encountered are potentially unacceptable.

From the *Department of Orthopedic Surgery, Miami Childrens Hospital, Miami, and †University of Florida College of Medicine, Gainesville, FL.

Acknowledgment date: May 1, 2006. Acceptance date: May 18, 2006.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Harry L. Shufflebarger, MD, Department of Orthopedic Surgery, Miami Childrens Hospital, 3100 SW 62nd Avenue, Miami, FL 33155-3009; E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.