Description of Scatter Radiation Exposure to the Eye Lenses and Direct Exposure to the Hands in Orthopedic and Spinal Procedures

Abstract

Introduction: The increasing adoption of minimally-invasive spinal surgery has resulted in more frequent use of fluoroscopy, heightening concerns regarding radiation-induced cataracts and hand skin cancer in spinal surgeons. We investigated indirect and direct radiation exposure during spinal and orthopedic procedures to enhance radiation protection and explored the factors associated with high dose.

Methods: We used data from 60 procedures performed in the operating and fluoroscopy rooms of a hospital in Japan between January and July 2024. Radiation doses to the eye lenses of the surgeon and scrub nurse and hands of the surgeon were measured using radiophotoluminescence glass dosimeters. Factors associated with high doses (≥0.1 mSv per procedure) were explored using the Wilcoxon rank-sum and Fisher's exact tests. We developed a preliminary predictive model using logistic regression to identify high doses, combine key predictors, and evaluate discriminative ability.

Results: In the 41 operating room procedures, the mean radiation dose to the left eye was higher than that to the right eye (0.038 mSv vs. 0.012 mSv), and the left-hand dose was also higher (0.105 mSv vs. 0.082 mSv). During the 19 fluoroscopy room procedures, the mean dose to the right eye was higher than that to the left eye (0.029 vs. 0.012 mSv), as was that to the hands (0.859 vs. 0.050 mSv). The surgeon's hand dose reached 7.7 mSv. High doses were associated with younger age (p=0.008), male sex (p=0.002), and obesity (p<0.001). A preliminary prediction model for high dose showed a c-statistic of 0.914 (95% confidence interval, 0.882–0.947).

Conclusion: This study highlights the need for better radiation protection for spinal procedures, including the increased use of lead goggles and measures to prevent direct hand exposure. Findings support larger studies to develop more accurate dose estimation formulas.