SPINE Volume 29, Number 22, pp 2573–2580 ©2004, Lippincott Williams & Wilkins, Inc. Occupational Gonadal and Embryo/Fetal Doses From Fluoroscopically Assisted Surgical Treatments of Spinal Disorders Nicholas Theocharopoulos, MSc,* John Damilakis, PhD,* Kostas Perisinakis, PhD,* George Papadokostakis, MD,† Alexander Hadjipavlou, MD,† and Nicholas Gourtsoyiannis, MD,‡ Study Design. Simulation of lumbar spine fluoroscopy used during surgical treatments of spinal disorders on a humanoid phantom and monitoring of the scattered radi- ation levels. Objectives. To assess the potential of adverse effects to progeny due to the preconceptual and embryo/fetal exposure to ionizing radiation resulting from the parental occupational exposure to scattered radiation from lumbar fluoroscopy. Summary of Background Data. There are no available data on embryo/fetal doses resulting from maternal oc- cupational exposure in the orthopedic theater. Besides, studies on staff gonadal doses from fluoroscopically as- sisted spine surgery are scarce and their results are not generally applicable. Methods. Lumbar spine anterior-posterior and lateral fluoroscopy were performed on an anthropomorphic phantom. Scattered radiation within the orthopedic the- ater was recorded at the staff genitals and waist level. Gonadal, abdominal surface, and embryo/fetal doses nor- malized to the dose-area-product specific to each projec- tion were calculated. Results. If the annual dose limits of occupational ex- posure are continuously exhausted for 10 years, the re- sulting radiogenic risk of congenital malformation in in- fants born to the orthopedic theater staff will be at least two orders of magnitude lower than the corresponding spontaneous probability. The occupational exposure of the pregnant mother bears a negligible contribution to the risk of hereditary effect on the newborn’s progeny compared with the natural incidence rate. Conclusions. Radiogenic genetic and embryo/fetal risks resulting from occupational exposure due to fluoro- scopically assisted surgical treatments of spinal disorders are well within tolerance levels provided that rigorous confinement to all pertinent occupational dose con- straints is established. Key words: occupational exposure, fetal dose, go- nadal dose, fluoroscopy, radiation, pedicle screw, kypho- plasty, vertebroplasty. Spine 2004;29:2573–2580 It is generally recognized that in recent years the use of fluoroscopy in the orthopedic theater is in constant raise. In orthopedic surgery, the required fluoroscopy time de- pends on the anatomic area treated, the adopted surgical technique, the seniority of the orthopedist, and the diffi- culty of the treated fracture. Previous studies have re- ported the radiation exposure to various body sites of the surgeon and the assisting staff from fluoroscopically as- sisted procedures. 1–15 These studies have shown that the levels of occupational exposure in the orthopedic theater vary widely with beam angulation, staff positioning, and shielding. Further issues of interest in occupational radiation protection are the assessment and minimization of the 1) risk of genetic effects on the offspring of the personnel and 2) radiation effects on the growing embryo/fetus in pregnant staff. Both topics call for accurate and extensive dosimetric data, regarding gonadal doses to the exposed personnel and embryo/fetal doses to pregnant staff, re- spectively. The aim of the present study was to provide compre- hensive dosimetric data on staff gonadal and embryo/ fetal doses from fluoroscopic projections commonly used in surgical treatments of spinal disorders. On the basis of the above results, genetic risk for the male and female personnel, maximum permissible workloads for the pregnant staff, as well as embryo/fetal dose and fetal risk estimates, regarding such procedures, were presented. Materials and Methods The fluoroscopic projections, typically used in image-guided surgery of spinal disorders, simulated on an anthropomorphic phantom were as follows: 1) lumbar spine anterior-posterior and 2) lumbar spine lateral 90°. All irradiations were per- formed with the phantom positioned prone on the surgical table, the focus to image intensifier distance fixed at 90 cm, and the radiation field centered on phantom slice 26, which corre- sponds to the fifth lumbar vertebra. 16 During anterior- posterior fluoroscopy, the focus was undercouch at 48 cm from the phantom entrance surface and the tube high voltage and current were 75 kVp and 1.2 mA, respectively. Lateral fluoros- copy was accomplished with the tube angulated 90° to the right From the *Department of Medical Physics, Faculty of Medicine, Uni- versity of Crete; †Department of Orthopaedics and Traumatology, University Hospital of Iraklion; and ‡Department of Radiology, Fac- ulty of Medicine, University of Crete, Crete, Greece. Acknowledgment date: July 6, 2003. First revision date: November 3, 2003. Acceptance date: December 16, 2003. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. Address correspondence and reprint requests to John Damilakis, PhD, Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, Iraklion 71003, Crete, Greece; E-mail: damilaki@med.uoc.gr 2573