Is Ocular Safety in Orthopaedics Overlooked? A Systematic Review of Annual Ocular Radiation Exposure and Protective Measures.

IF 4.2 2区 医学 Q1 ORTHOPEDICS
Keith E Arnold, Victoria Whitmore, Christian J Hecht, Joshua R Porto, Atul F Kamath
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引用次数: 0

Abstract

Background: Intraoperative fluoroscopy is increasingly common in orthopaedics, although recent guidelines have reduced the maximum recommended exposure to 20 mSv annually. A systematic review of the literature was conducted to comprehensively assess current adherence to exposure guidelines, identify practice settings at increased risk for exposure, and determine the best practices and personal protective equipment for ocular radiation risk mitigation.

Questions/purposes: In this systematic review we asked: (1) Is the annual amount of eye irradiation received by orthopaedic surgeons below the recommended limit of 20 mSv? (2) What is the effectiveness of leaded glasses in reducing the eye's exposure to radiation? (3) Which imaging setups and operative techniques reduce ocular irradiation?

Methods: PubMed, Medline, EBSCOhost, and Google Scholar were queried on September 28, 2023, to identify studies assessing intraoperative ocular radiation exposure among orthopaedic surgeons. Studies that measured radiation in or around the eye (such as the bridge of the nose or eyebrows) during orthopaedic procedures were included. Exclusion criteria were duplicate studies, studies that only estimated eye radiation based on the radiation dose recorded at parts of the body distant from the eyes, nonoriginal research, case reports, and articles without full-text English versions available. A total of 393 unique articles were retrieved, and after title, abstract, and full-text screening, 23 dosimetry studies were included, comprising 12 prospective observational studies, 7 phantom models, 1 cadaver model, 2 observational studies, and 1 randomized control trial. Risk of bias was determined via the Methodological Index for Nonrandomized Studies (MINORS) tool. Study quality was generally good to excellent, with noncomparative studies having a mean MINORS score of 14 ± 0 of 16 and comparative studies achieving a mean score of 19 ± 1 of 24, with higher scores representing better study quality. Due to extensive heterogeneity in study design, a meta-analysis was not conducted, with the results rather presented as a narrative summary of key findings.

Results: The vast majority of surgeons conducting a variety of orthopaedic and traumatologic procedures were not exposed to a hazardous level of eye irradiation annually, but surgeons who perform a high volume of fluoroscopy-intensive procedures may exceed guidelines. Leaded eyeglasses reduced eye radiation by about 90%, with sport wrap-around glasses offering better shielding than alternatives, although leaded glasses overall were largely underutilized. Positioning mini C-arms in the standard vertical configuration was shown to provide up to a 13-fold decrease in radiation exposure compared with inverted configuration, while standing perpendicular to the fluoroscope further reduced eye irradiation.

Conclusion: We found that orthopaedic surgeons who perform a high volume of fluoroscopy-intensive procedures may be at risk of exceeding recommendations on annual radiation exposure, although exposure can be mitigated through various simple strategies. In particular, this analysis found that the use of sport wrap-around leaded glasses, positioning of mini-C arms in the standard vertical configuration, and standing perpendicular to the fluoroscope provide the most effective means of limiting ocular radiation exposure. As ophthalmic radiation exposure presents a potentially important occupational health hazard to orthopaedic surgeons, further investigations of radiation exposure specific to high-volume, fluoroscopy-intensive orthopaedic practices and long-term ophthalmic outcomes will help determine the extent of the potential harm posed by frequent exposure to intraoperative radiation over the span of a career.

Level of evidence: Level III, therapeutic study.

矫形外科的眼部安全是否被忽视?年度眼部辐射暴露和防护措施的系统回顾。
背景:术中透视在骨科越来越常见,尽管最近的指南已将每年的最大建议照射量减少到 20 毫西弗。我们对文献进行了系统性回顾,以全面评估目前对暴露指南的遵守情况,确定暴露风险增加的实践环境,并确定降低眼部辐射风险的最佳实践和个人防护设备:在这篇系统综述中,我们提出了以下问题:(1)矫形外科医生每年接受的眼部辐照量是否低于建议的 20 mSv 限值? 2)含铅眼镜在减少眼部辐照方面的效果如何?(3) 哪些成像设置和手术技术可减少眼部辐照?于 2023 年 9 月 28 日查询了 PubMed、Medline、EBSCOhost 和 Google Scholar,以确定评估矫形外科医生术中眼部辐照的研究。研究纳入了在骨科手术过程中测量眼内或眼周(如鼻梁或眉毛)辐射的研究。排除标准包括重复研究、仅根据远离眼睛的身体部位记录的辐射剂量估算眼部辐射的研究、非原创性研究、病例报告以及没有全文英文版本的文章。共检索到 393 篇文章,经过标题、摘要和全文筛选,共纳入 23 项剂量测定研究,包括 12 项前瞻性观察研究、7 项模型试验、1 项尸体模型试验、2 项观察研究和 1 项随机对照试验。偏倚风险通过非随机研究方法指数(MINORS)工具确定。研究质量一般为良好至优秀,非对比研究的 MINORS 平均得分为 14 ± 0(16 分),对比研究的 MINORS 平均得分为 19 ± 1(24 分),得分越高代表研究质量越好。由于研究设计存在广泛的异质性,因此没有进行荟萃分析,而是将结果作为主要研究结果的叙述性总结:结果:绝大多数进行各种骨科和创伤外科手术的外科医生每年暴露于眼部辐照的危险水平并不高,但进行大量荧光透视密集手术的外科医生可能会超过指南要求。含铅眼镜可减少约 90% 的眼部辐射,其中运动型环绕眼镜的屏蔽效果优于其他眼镜,但含铅眼镜的总体使用率很低。与倒置配置相比,以标准垂直配置摆放迷你 C 臂可将辐照减少 13 倍,而垂直于荧光屏站立则可进一步减少眼部辐照:我们发现,执行大量透视密集型手术的骨科医生可能会面临年度辐照量超过建议值的风险,尽管可以通过各种简单的策略来减少辐照量。特别是,该分析发现,使用运动型环形有框眼镜、将微型 C 臂置于标准垂直配置位置以及垂直于荧光屏站立是限制眼部辐照的最有效方法。由于眼科辐射照射对骨科医生的职业健康具有潜在的重要危害,因此,进一步调查高产量、荧光透视密集型骨科手术的特定辐射照射情况以及长期眼科治疗结果,将有助于确定在职业生涯中频繁暴露于术中辐射所造成的潜在危害程度:证据等级:三级,治疗性研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.00
自引率
11.90%
发文量
722
审稿时长
2.5 months
期刊介绍: Clinical Orthopaedics and Related Research® is a leading peer-reviewed journal devoted to the dissemination of new and important orthopaedic knowledge. CORR® brings readers the latest clinical and basic research, along with columns, commentaries, and interviews with authors.
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