Radiation Exposure to the Surgeons and Patients in Fluoroscopic-Guided Segmental Pedicle Screw Placement for Pediatric Scoliosis

Study Design. Prospective case series. Objective. To analyze the radiation exposure to the surgeons and patients in fluoroscopic-guided segmental pedicle screw placement for pediatric scoliosis. Summary of Background Data. Fluoroscopic-guided pedicle screw placement is a safer technique for pedicle screw placement in spinal deformity. However, radiation exposure is a concern, particularly for spine surgeons due to the requirement of multiple pedicle screws in spinal deformity surgery. Methods. We measured radiation dose to the surgeons and pediatric patients undergoing scoliosis surgery by a team of two surgeons (S1 and S2) from March 2016 to December 2017. Surgery was performed using fluoroscopic-guided segmental pedicle screw placement. The dosimeters were placed at the forehead, inside and outside thyroid shield, both hands, back, and suprapubic under lead apron for each surgeon; and at the thyroid and gonads for patients. Results. Thirty patients were included in the study. The mean numbers of pedicle screws per case were 23.2 +/- 3.4. The mean dose (mrem) per case for the two surgeons S1 and S2 was 0.07 and 0.47 at forehead, 0.07 and 0.37 at outside thyroid shield, 0.00 and 0.30 at inside thyroid shield, 16.87 and 13.73 at right hand, 6.07 and 11.37 at left hand, 0.50 and 0.00 at back, and 0.00 and 0.00 at suprapubic under lead apron, respectively. The mean dose (mrem) per case for the male and female patient was 3.67 and 14.71 for thyroid and 3.83 and 3.17 for gonads, respectively. Conclusion. The results of this study demonstrated that radiation exposure to the spine surgeons and patients is low using fluoroscopic-guided segmental pedicle screw technique for pediatric scoliosis surgery. Both hands of the surgeons received much higher doses compared to other body areas and, and thus radiation-reducing gloves and careful attention to surgeon's hands need to be considered for this procedure.