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      Risk and radiation exposure in orthopedic surgery of the spine in Mexico Translated title: Riesgo y exposición a radiaciones en cirugía ortopédica de columna vertebral en México Translated title: Risco e exposição à radiação em cirurgia ortopédica da coluna no México

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          Abstract

          OBJECTIVE: To find a biological effect by means of detection of the thyroid profile in research personnel, and a physical effect through radiation detection plates type Durr. METHODS: Five medical residents (four of first year and one of second) were submitted to the study of the basal thyroid profile, and annually after a year of radiation exposure. In two of them five plates of Durr type were placed by surgery at different body parts and 20 separate surgeries, using fluoroscopy, a total of 200 plates exposed. RESULTS: Three residents had decreased thyroid-stimulating hormone and two had a significant increase. Ninety-one plates were exposed, most of which corresponds to the neck (thyroid). CONCLUSION: Biological and physical changes were observed that require us to realize and implement protective measures against radiation, at least in the neck, because the thyroid is susceptible to radiation.

          Translated abstract

          OBJETIVO: Encontrar un efecto biológico mediante detección de perfil tiroideo al personal investigador, y un efecto físico mediante detección de radiación con placas tipo Durr. MÉTODOS: Fueron sometidos al estudio, cinco médicos residentes, (cuatro de primer año y uno de segundo) para el perfil tiroideo basal, y anual después de un año de radiación. A dos de ellos les fueron colocadas cinco placas de Durr por cirugía, distribuidas en diferentes partes del cuerpo en 20 cirugías distintas con la utilización de fluoroscopio, dando un total de 200 placas expuestas. RESULTADOS: En tres de los residentes hubo una disminución de la hormona tiroidea estimulante y en dos un aumento significativo. Se expusieron 91 placas siendo la mayoría de estas correspondientes al cuello (tiroides). CONCLUSIÓN: Se encontraron cambios biológicos y físicos que nos impelen a tomar conciencia y medidas necesarias de radioprotección por lo menos a nivel del cuello, ya que la tiroides es susceptible a las radiaciones

          Translated abstract

          OBJETIVO: Encontrar um efeito biológico através da detecção do perfil da tireoide dos profissionais de investigação, e um efeito físico através da detecção de radiação com placas tipo Durr. MÉTODOS: Cinco médicos residentes (quatro de primeiro ano e um de segundo) foram submetidos ao estudo do perfil tireoidiano basal, e anualmente após um ano de exposição à radiação. Em dois deles, foram colocadas cinco placas de Durr por cirurgia, em diferentes partes do corpo e em 20 cirurgias distintas, utilizando-se fluoroscopia, perfazendo um total de 200 placas expostas. RESULTADOS: Três residentes tiveram diminuição do hormônio estimulador da tireoide e dois, um aumento significativo. Foram expostas 91 placas, cuja maioria corresponde ao pescoço (tireoide). CONCLUSÃO: Foram verificadas mudanças biológicas e físicas que nos impulsionam à conscientização e implementação de medidas de proteção contra a radiação, pelo menos no pescoço, uma vez que a tireoide é suscetível à radiação.

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          Occupational radiation exposure to the surgeon.

          Increased use of intraoperative fluoroscopy exposes the surgeon to significant amounts of radiation. The average yearly exposure of the public to ionizing radiation is 360 millirems (mrem), of which 300 mrem is from background radiation and 60 mrem from diagnostic radiographs. A chest radiograph exposes the patient to approximately 25 mrem and a hip radiograph to 500 mrem. A regular C-arm exposes the patient to approximately 1,200 to 4,000 mrem/min. The surgeon may receive exposure to the hands from the primary beam and to the rest of the body from scatter. Recommended yearly limits of radiation are 5,000 mrem to the torso and 50,000 mrem to the hands. Exposure to the hands may be higher than previously estimated, even from the mini C-arm. Potential decreases in radiation exposure can be accomplished by reduced exposure time; increased distance from the beam; increased shielding with gown, thyroid gland cover, gloves, and glasses; beam collimation; using the low-dose option; inverting the C-arm; and surgeon control of the C-arm.
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            Occupational Radiation Exposure to the Surgeon

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              Radiation exposure with use of the inverted-c-arm technique in upper-extremity surgery.

              Intraoperative fluoroscopy is commonly used in surgical procedures on upper extremities. We compared radiation exposure from two possible positions of the mobile digital fluoroscopy unit (c-arm): (1) the standard technique, with the x-ray tube down (near the floor) and the image intensifier at the top of the c-arm, and (2) the inverted position, in which the image intensifier is used as a table and the x-ray tube is up. A commercially available c-arm was used to irradiate a phantom hand in one of three configurations. In the first, the phantom hand was placed on an armboard equidistant from the x-ray tube and the image intensifier with the beam directed upward. In the second, the c-arm was inverted with the beam directed downward and the image intensifier used as a table. The third configuration was identical to the second except that a magnified image was used. Radiation exposure was measured at four locations corresponding to the approximate position of the surgeon's head, chest, and groin and the patient's hand. The amount of radiation exposure to both the surgeon and the patient was significantly less when the c-arm was used in the inverted position (p < 0.0001). The dose rate to the patient's hand was reduced by 59%. The radiation exposure to the surgeon's head, body, and groin with the inverted-c-arm technique was 67%, 45%, and 15% of the measured doses with the x-ray-tube-down configuration. When we used the magnification mode of the image intensifier, with its correspondingly smaller field size, the doses were further reduced to 46%, 32%, and 11% of the standard-configuration values. Use of the inverted-c-arm technique with the image intensifier as an operating table can significantly reduce radiation exposure to the surgeon and the patient during surgical procedures on upper extremities.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                coluna
                Coluna/Columna
                Coluna/Columna
                Sociedade Brasileira de Coluna (São Paulo )
                2177-014X
                March 2015
                : 14
                : 1
                : 41-44
                Affiliations
                [1 ] Hospital Civil Fray Antonio Alcalde Mexico
                Article
                S1808-18512015000100041
                10.1590/S1808-1851201514010R126
                99e1ae13-7768-42e5-8bc3-c4c1ada05c6c

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1808-1851&lng=en
                Categories
                ORTHOPEDICS
                REHABILITATION

                Orthopedics,Physiotherapy
                Fluoroscopy,Radiation,Risk factors,Orthopedics,Humans,Fluoroscopía,Radiación,Factores de riesgo,Ortopedia,Humanos,Fluoroscopia,Radiação,Fatores de riscos

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