Intraoperative Ionizing Radiation Exposure Awareness and Associated Morbidity in Neurosurgery

Introduction: Neurosurgeons often use radiation to visualize blood vessels and implants intraoperatively. However, high exposure to radiation increases one’s cancer risk. This study aims to investigate intraoperative ionizing radiation exposure awareness and associated morbidity among neurosurgeons.

Methods: An anonymized 30-question survey was disseminated to 3,344 American Association of Neurological Surgeons members. Participants were questioned about their intraoperative radiation exposure, protective measures, radiation knowledge, and any conditions that can arise from protracted radiation exposure.

Results: A total of 227 (6.8%) neurosurgeons completed the survey. Most neurosurgeons (61, 27%) performed 2-4 surgeries per week necessitating radiation (61, 27%), did not use a dosimeter (134, 59%), and wore a lead apron (89%) and a thyroid shield (75%). Only 7 (3%) of respondents could correctly identify the safety limit on occupational radiation. One hundred and thirty-four (59%) respondents correctly identified the relationship between distance and radiation dose reduction. Two hundred and thirteen (94%) neurosurgeons reported concern about occupational radiation exposure. No significant association was found between occupational radiation exposure and the rate of cataracts, combined cancer, and skin cancer. Multivariate logistic regression adjusting for age and familial cancer history found that the likelihood of developing leukemia (OR: 1.26; 95% CI: 1.06-1.61; p=0.02) and non-malignant thyroid nodular disease (OR: 1.25; 95% CI: 1.08-1.55; p=0.01) was positively associated with increased with increased total occupational radiation exposure .

Conclusion : There is a need for improved radiation safety awareness among neurosurgeons, especially in the context of rising usage of minimally invasive surgery. Further research into barriers preventing greater compliance to radiation-reducing strategies is warranted. This can allow for a greater understanding of radiation-associated risks among neurosurgeons and guide the implementation of safer practices.