Radiation dose reduction to medical staff during vertebroplasty: a review of techniques and methods to mitigate occupational dose.

STUDY DESIGN: Case crossover design was conducted. OBJECTIVES: The purpose of the current study was to determine the radiation exposure level of operators performing fluoroscopically assisted vertebroplasty and to determine optimal techniques to reduce this exposure. SUMMARY OF BACKGROUND DATA: The use of ionizing radiation to provide quality imaging during minimally invasive orthopedic procedures has dramatically increased. One such procedure, vertebroplasty, which is the percutaneous fixation of fractured vertebrae with polymethylmethacrylate, requires the use of ionizing radiation of biplanar fluoroscopy. The adverse effects of excessive radiation exposure to occupational personnel may not be realized for several years. METHODS: Twelve months of occupational dose data for a single operator were evaluated and correlated to the modifications of practice habits implemented and shielding techniques used to reduce the operator's exposure while maintaining adequate image quality. RESULTS: Before the implementation of radiation-reduction procedures, the average whole-body dose per vertebroplasty procedure was 1.44 mSv/vertebrae, and the measured hand dose was 2.04 mSv/vertebrae. After implementation of radiation-reducing procedures and shielding techniques, the average whole-body dose per vertebroplasty procedure was 0.004 mSv/vertebrae, and the average hand dose was 0.074 mSv/vertebrae. Testing of the shielding device indicated a significant reduction in whole-body and hand doses. For the fluoroscopic modes investigated, the shielding used resulted in reductions ranging from 42.9% to 86.1%. CONCLUSION: It is critical that operators performing vertebroplasty procedures have a fundamental understanding of radiation physics and radiation protection to minimize radiation exposure.