Abstract
Purpose
The purpose of this study was to compare exposure of patient and operator to ionising radiation during percutaneous vertebroplasty performed under combined computed tomography (CT) and fluoroscopic guidance or fluoroscopic guidance alone.
Materials and methods
With the collaboration of our physics department, we measured exposure on ten patients undergoing vertebroplasty with combined CT and fluoroscopic guidance and on ten undergoing vertebroplasty with fluoroscopic guidance alone.
Results
Mean operator dose was approximately 0.8 microSv during vertebroplasty done with combined CT and fluoroscopic guidance and 5.8 microSv in procedures with fluoroscopic guidance alone. Mean patient dose was approximately 6 mSv for combined guidance and 8 mSv for fluoroscopic guidance, a difference that was not found to be statistically significant.
Conclusions
Although combined CT and fluoroscopic guidance is normally preferred for difficult areas such as the cervical and upper thoracic vertebrae, to ensure operator radiation protection, the technique should also be considered for areas normally treated under fluoroscopic guidance alone. However, a larger patient series is needed to correctly evaluate the real contribution of low-dose CT to patient exposure.
Riassunto
Obiettivo
Scopo del lavoro è confrontare la dose a cui sono esposti paziente e operatore in corso di vertebroplastica percutanea sotto guida combinata TC e radioscopica e sotto esclusiva guida radioscopica.
Materiali e metodi
In collaborazione con la fisica sanitaria abbiamo eseguito misurazioni su 10 pazienti sottoposti a vertebroplastica con guida combinata e su 10 pazienti sottoposti a vertebroplastica con guida esclusivamente radioscopica.
Risultati
In base a questo studio si osserva come la dose all’operatore sia in media circa 0,8 microSv in corso di vertebroplastica eseguita con guida combinata TC e radioscopica, mentre si attesti attorno a 5,8 microSv se eseguita con guida esclusivamente radioscopica; per quanto riguarda i pazienti la dose è di circa 6 mSv per la guida combinata e circa 8 mSv nel caso di guida esclusivamente radioscopica; tale differenza non risulta statisticamente significativa.
Conclusioni
Se la guida combinata TC e radioscopica risulta preferibile per sedi complesse come il trattamento a livello del rachide cervicale e dorsale “alto” essa è da prendersi in considerazione qualora si privilegi la protezionistica dell’operatore anche per quei metameri vertebrali solitamente trattati con esclusiva guida radioscopica, tuttavia serve una più ampia casistica per poter valutare il reale contributo della TC a basso dosaggio nell’esposizione del paziente.
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Tappero, C., Barbero, S., Costantino, S. et al. Patient and operator exposure during percutaneous vertebroplasty. Radiol med 114, 595–607 (2009). https://doi.org/10.1007/s11547-009-0385-7
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DOI: https://doi.org/10.1007/s11547-009-0385-7