Presentation Authors: John Smith, Loma Linda , CA, Mohammad Hajiha*, Akin Amasyali, Loma Linda, CA, Zahabiya Campwala, Loma Linda , CA, Hyelin You, Muhannad Alsyouf, Loma Linda, CA, Jon Ewald, Andrew Krause, Daniel Baldwin, Reihaneh Moghisi, D.Duane Baldwin, Loma Linda , CA
Introduction: Although surgeons wear lead to protect themselves from scattered radiation, the effect of shielding upon scattered radiation has not been well characterized. In addition, conventional lead aprons still leave other body parts including the legs and head unprotected. The aim of this study is to determine the surgeon radiation exposure at multiple sites with and without shielding during a simulated percutaneous nephrolithotomy (PCNL).
Methods: A cadaver &[Prime]patient&[Prime] (BMI 24.6) was positioned supine and a cadaver &[Prime]surgeon&[Prime] (BMI 20.7) was placed upright 11 inches from the radiation source to simulate the position of the surgeon during PCNL. Ten total trials of 20 minutes were completed, 5 trials with the surgeon wearing a 0.35 mm lead body apron and thyroid shield and 5 trials without lead. Dosimeters were placed in the &[Prime]surgeon&[Prime] over sensitive organs divided into three groups, upper body (thyroid, lung, sternum), lower body (liver, kidney, bladder, sigmoid and male gonads) and unshielded areas (Tibia, head). A T-test was used with statistical significance level set at p < 0.05.
Results: A 96% reduction (p < 0.001) in radiation was recorded between shielded (12.8 mrem) and unshielded (323.1 mrem) organs. For shielded trials, the organs with highest radiation exposure were the sigmoid colon (19.6 mrem), bladder (15.6 mrem), and sternum (13.6 mrem). Organs showing the lowest exposure were the thyroid (9 mrem), lungs (10.2 mrem), and liver (10.4 mrem). In shielded groups, upper body organs had 22% lower radiation dose than those in the lower body (10.9 mrem vs. 14.0 mrem, p=0.02). In the unshielded group, the upper body received 25% lower dose than the lower body (264.3 mrem vs. 356.3 mrem, p=0.02). When comparing shielded vs. unshielded groups, radiation exposure of the head (102.6 mrem vs. 100.4, p=.938) and tibia (268.4 mrem vs. 284.6 mrem, p=0.723) was similar.
Conclusions: Although standard radiation protection measures dramatically reduce exposure, they may not be adequate in protecting certain radiation sensitive organs like the sigmoid and bladder. Furthermore, body parts like the tibia and head continue to receive large radiation exposure whether or not the surgeon wears conventional radiation protection. Therefore, in addition to wearing lead shielding, surgeons should take measures to reduce the fluoroscopy time and dose.