Practical Assessment of Radiation Exposure in Spine Surgery

World Neurosurg. 2018 Dec;120:e752-e754. doi: 10.1016/j.wneu.2018.08.158. Epub 2018 Aug 30.


Background: Fluoroscopy use in spine surgery is increasing owing to the increasing popularity of minimally invasive techniques. The effectiveness and safe distance for protective barriers might have been commonly misrepresented. The present study evaluated x-ray propagation and the efficacy of protective barriers in the setting of spine surgery.

Methods: A high-accuracy radiation dosimeter was used to measure x-ray exposure in an experimental setting replicating the spine surgery setup. Radiation was measured at different angles and distances from the x-ray source with and without protective barriers such as lead gowns and glass.

Results: The radiation values return to baseline at 14 ft (4.3 m) in front of the x-ray source and 8 ft (2.4 m) behind it. Protective barriers with a 0.5-mm lead-equivalence reduced radiation exposure to baseline at 6 ft (1.8 m) and were 20% effective at 2 ft (0.6 m) from the emitter.

Conclusion: Spine surgeons who wear lead gowns during fluoroscopy could still be exposed to <80% of the radiation produced. Safe distances from fluoroscopy machines might be much farther than commonly believed. Alternatives to reduce the use of fluoroscopy for intraoperative imaging should be explored.

Keywords: Fluoroscopy; Occupational hazard; Radiation; Spine surgery; X-ray.

MeSH terms

  • Fluoroscopy* / adverse effects
  • Humans
  • Minimally Invasive Surgical Procedures / adverse effects
  • Occupational Exposure* / prevention & control
  • Operating Rooms
  • Orthopedic Procedures
  • Radiation Dosage
  • Radiation Exposure* / prevention & control
  • Radiation Protection
  • Spine / diagnostic imaging*
  • Spine / surgery*
  • Surgeons
  • Surgery, Computer-Assisted* / adverse effects
  • X-Rays