Occupational Radiation Exposure in Spine Surgery: Organ-specific OSL Phantom Dosimetry and Workload-based Risk Assessment.

Abstract

Occupational radiation exposure during fluoroscopy-guided dorsolumbar spine surgery was evaluated using ATOM phantoms and carbon-doped aluminium oxide (Al2O3:C) nanoDot optically stimulated luminescence (OSL) dosemeters. A controlled 50-acquisition protocol (comprising anteroposterior, oblique, and lateral projections) was used to map organ-specific doses for an operating surgeon at 50 cm from the C-arm isocentre. The expanded measurement uncertainty was 7.6% (k=2).

In the unprotected configuration, the highest equivalent doses occurred in the thoracic region, specifically the breasts (0.0430 mSv/procedure), oesophagus (0.0335 mSv/procedure), lungs (0.0230 mSv/procedure), and stomach (0.0280 mSv/procedure). Standard protective equipment (0.5 mm Pb-equivalent) reduced these organ doses by 27.3% to 42.9%. However, these reduction factors characterise the complete geometric setup rather than the intrinsic attenuation of individual shielding devices.

Based on International Commission on Radiological Protection (ICRP) Publication 103 tissue-weighting factors, the calculated effective dose was 0.152 mSv per simulated procedure. Illustrative workload extrapolations (E_annual = 0.1519 x N) yielded cumulative annual effective doses of 14.58 mSv/year for 96 procedures and 36.45 mSv/year for 240 procedures. These scenario-based projections are highly specific to the evaluated setup, table height, and acquisition parameters. The findings support the utility of local kerma-area product (KAP)-normalised dose audits, rigorous individual monitoring, and the consideration of conditional Category A classification for high-volume spine surgeons where comparable exposures are verified by local clinical practice.