Radiation Shielding Effect of Surgical Loupes Compared with Lead-Lined Glasses and Plastic Face Shields.

Background

Fluoroscopy plays a crucial role in various medical procedures, especially in orthopaedic and spinal surgery. However, concerns have arisen regarding ocular radiation exposure given its association with posterior lens opacities and cataracts. Protective measures are essential to mitigate ocular radiation exposure. During spine surgery, loupes are frequently used but often lack lead lining. The purpose of the present study was to assess the effect of surgical loupes, as compared with lead glasses and plastic face shields, on ocular radiation exposure.

Methods

Dosimeters were positioned anterior (unshielded) and posterior (shielded) to the lens of each type of eyewear: lead glasses, surgical loupes, and plastic face shields. Eyewear/dosimeters were exposed directly to the horizontal beam of a C-arm for 2 minutes of continuous fluoroscopy. This was repeated 20 times for each type of eyewear (40 total/eyewear, 120 times overall). Radiation doses were modeled with use of generalized estimating equations with a Gaussian distribution and identity link function. Separate models were employed for each outcome, including eyewear category (lead glasses, loupes, plastic shield) and dosimeter position (anterior/unshielded versus posterior/shielded).

Results

Radiation dose was significantly lower in posterior compared with anterior dosimeters for lead glasses (0.00 versus 1,689.80 mRem; p < 0.001) and for loupes (20.27 versus 1,705.95 mRem; p < 0.001). The difference for plastic face shields did not reach significance (1,539.75 versus 1,701.45 mRem; p = 0.06). Lead glasses offered the most protection, followed by surgical loupes and then plastic shields, when comparing the shielded dosimeter readings (0.00 versus 20.27 versus 1,539.75; p < 0.001 for all comparisons). There was no significant difference in radiation dose for dosimeters placed anterior to lead glasses, loupes, and plastic face shields (1,689.80 versus 1,705.95 versus 1,701.45 mRem; p = 0.99).

Conclusions

Lead glasses were most effective (∼100% reduction), followed by surgical loupes (97%), whereas plastic face shields showed no significant reduction in radiation dose. Surgical loupes can substantially reduce ocular radiation exposure.

Clinical relevance

Surgical loupes may offer ocular radiation protection.

COI Statement

Disclosure: No external funding was received for this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/I496 ).

References:

• Hayda RA, Hsu RY, DePasse JM, Gil JA. Radiation Exposure and Health Risks for Orthopaedic Surgeons. J Am Acad Orthop Surg. 2018 Apr 15;26(8):268-1-7.
• Socol Y, Dobrzyński L. Atomic Bomb Survivors Life-Span Study: Insufficient Statistical Power to Select Radiation Carcinogenesis Model. Dose Response. 2015 May 4;13(1):1-1-7.
• Kesavachandran CN, Haamann F, Nienhaus A. Radiation exposure of eyes, thyroid gland and hands in orthopaedic staff: a systematic review. Eur J Med Res. 2012 Oct 30;17(1):28.
• Apelmann C, Kowald B, Weinrich N, Dischinger J, Nienhaus A, Seide K, Martens H, Jürgens C. Radiation Dose to the Eye Lens Through Radiological Imaging Procedures at the Surgical Workplace During Trauma Surgery. Int J Environ Res Public Health. 2019 Oct 11;16(20):3850.
• Cheriachan D, Hughes AM, du Moulin WSM, Williams C, Molnar R. Ionizing Radiation Doses Detected at the Eye Level of the Primary Surgeon During Orthopaedic Procedures. J Orthop Trauma. 2016 Jul;30(7):e230-1-7.