Roccatagliata L, Presilla S, Pravatà E, Cianfoni A. Radiation dose to the operator during fluoroscopically guided spine procedures. Neuroradiology. 2017 Sep;59(9):885-892.

Fluoroscopy is widely used to guide diagnostic and therapeutic spine procedures. The purpose of this study was to quantify radiation incident on the operator (operator Air Kerma) during a wide range of fluoroscopy-guided spine procedures and its correlation with the amount of radiation incident on the patient (Kerma Area Product-KAP).

Reißberg S, Ludeke L, Fritsch M. Comparison Of Radiation Exposure Of The Surgeon In Minimally Invasive Treatment Of Osteoporotic Vertebral Fractures – Radiofrequency Kyphoplasty Versus Balloon Kyphoplasty With Cement Delivery Systems (CDS). Röfo. 2020 Jan;192(1):59-64.

The aim of the present study was to compare the radiation exposure of the surgeon when using two different kyphoplasty systems for the minimally invasive treatment of osteoporotic vertebral body fractures. The measured surface doses for the lenses were four times higher in balloon kyphoplasty. For the left wrist, the values for balloon kyphoplasty were about 8 times higher.

Rashid MS, Aziz S, Haydar S, et al. Intra-operative fluoroscopic radiation exposure in orthopaedic trauma theatre. Eur J Orthop Surg Traumatol. 2018 Jan;28(1):9–14.

This study aimed to report appropriate intra-operative fluoroscopy use in orthopaedic trauma and compare the effect of surgery type and surgeon grade on radiation exposure. Median DAP for dynamic hip screws for extracapsular femoral neck fractures was 668 mGy/cm2 (ST 36 s), 1040 mGy/cm2 (ST 49 s) for short proximal femoral nail, 1720 mGy/cm2 (ST 2 m 36 s) for long femoral nail for diaphyseal fractures, 25 mGy/cm2 (ST 25 s) for manipulation and Kirschner wire fixation in distal radius fractures, and 27 mGy/cm2 (ST 23 s) for volar locking plate fixation in distal radius fractures. These represented the five commonest procedures performed in the trauma operating room in our hospital. Experienced surgeons utilized less radiation in the operating room than junior surgeons (DAP 90.55 vs. 366.5 mGy/cm2, p = 0.001) and took fewer fluoroscopic images (49 vs. 66, p = 0.008) overall.

Plastaras C, Appasamy M, Sayeed Y, et al. Flouroscopy procedure and equipment changes to reduce staff radiation expsoure in the interventional spine suite. Pain Physician. Nov-Dec 2013;16(6):E731-E738.

The goal of this study was to quantify effective dose rates to staff before and after interventions. A total of 685 interventional procedures were performed in the pre-intervention period and 385 in the post-intervention period. The median cumulative mrem (interquartile range) for all staff combined in the pre-intervention period was 71 (28,75) and post-intervention period was 1 (0,3). The median mrem per procedure was significantly higher in the pre-intervention group 0.46 (0.36, 0.54) compared to post-intervention 0.01 (0.0.03); P < 0.01. The percentage reduction in overall effective dose per procedure to all staff was 97.3%.

Perry BC, Monroe EJ, McKay T, et al. Pediatric Percutaneous Osteoid Osteoma Ablation: Cone-Beam CT with Fluoroscopic Overlay Versus Conventional CT Guidance. Cardiovasc Intervent Radiol. 2017 Oct;40(10):1593-1599.

To compare technical success, clinical success, complications, radiation dose, and total room utilization time for osteoid osteoma thermal (radiofrequency or microwave) ablation using cone-beam computed tomography (CBCT) with two-axis fluoroscopic navigational overlay versus conventional computed tomography (CT) guidance.

Paul J, Mbalisike EC, Vogl TJ. Radiation Dose To Procedural Personnel And Patients From An X-Ray Volume Imaging System. Eur Radiol. 2013 Dec;23(12):3262-3270.

Radiation dose and image quality estimation of three X-ray volume imaging (XVI) systems. Mean DAP and SED were lower in recent XVI than its previous counterparts in CBCT, DSA and DF. HU of all measured locations was non-significant between the groups except the hepatic artery. Noise showed significant difference among groups (P<0.05). Regarding CNR and SNR, the recent XVI showed a higher and significant difference compared to its previous versions. Qualitatively, CBCT showed significance between versions unlike the DSA and DF which showed non-significance

McArthur BA, Schueler BA, Howe BM, et al. Radiation Exposure during Fluoroscopic Guided Direct Anterior Approach for Total Hip Arthroplasty. J Arthroplasty. 2015 Sep;30(9):1565-8.

Fluoroscopic guidance is commonly utilized during direct anterior total hip arthroplasty (DA THA). The purpose of this study was to measure patient and surgeon exposure utilizing this technique. Fifty-one consecutive patients who underwent primary DA THA by a single surgeon were prospectively studied. Fluoroscopic guidance was utilized according to an established protocol. Dose-area product (DAP) (Gy-cm(2)) and fluoroscopy time were recorded for each case.

Mayekar EM, Bayrak A, Shah S, Mejia A. Radiation Exposure to the Orthopaedic Surgeon and Efficacy of a Novel Radiation Attenuation Product. J Surg Orthop Adv. 2017 WINTER;26(4):246-249.

The purpose of this study was to examine the intraoperative radiation dosage to different body parts and to determine the effectiveness of a new lightweight radiation-attenuating fabric (XPF) versus lead, the current standard. For 51 cases involving fluoroscopy, one attending orthopaedic surgeon wore a set of three dosimeters at various locations. Per each set of three, one dosimeter was shielded with a swatch of XPF, one was placed underneath the lead apron, and one was left exposed.