臨床整形外科55巻2号

2020年02月発行

特集 整形外科の職業被曝

X線透視による脊椎外科医の職業被曝の実際—未固定遺体より学ぶ

著者： 山下一太¹

所属機関： ¹徳島大学大学院運動機能外科学(整形外科)

ページ範囲：P.133 - P.141

　低侵襲医療の発展により，X線透視の使用量は増大傾向にある．それに伴って，医療者の職業被曝量も増加しており，その手技内容上，特に脊椎外科領域では手や眼への被曝量は多く，被曝による悪影響が懸念されている．職業被曝の基本的知識について整理し，特に脊椎外科医に関わる職業被曝を中心に詳述する．整形外科医，特に脊椎外科医は自分および患者への被曝を意識し，被曝量低減に努める必要がある．

参考文献

1) Frazier TH, Richardson JB, Fabré VC, et al. Fluoroscopy-induced chronic radiation skin injury:a disease perhaps often overlooked. Arch Dematol 2007;143(5):637-40.

2) Chambers JA, Long JN. Radiation injury and the hand surgeon. J Hand Surg Am 2008;33(4):601-11.

3) Liu X, Liu JZ, Zhang E, et al. Impaired wound healing after local soft x-ray irradiation in rat skin:time course study of pathology, proliferation, cell cycle, and apoptosis. J Trauma 2005;59(3):682-90.

4) Brenner DJ, Doll R, Goodhead DT, et al. Cancer risks attributable to low doses of ionizing radiation:assessing what we really know. Proc Natl Acad Sci USA 2003;100(24):13761-6.

5) Adelstein SJ. Uncertainty and relative risks of radiation exposure. JAMA 1987;258(5):655-7.

6) International Commission on Radiological Protection, 1990 Recommendations of the International Commission on Radiological Protection ICRP Publication 60. Ann ICRP 1991;21:1-3.

7) ICRP. Radiological Protection and Safety in Medicine. ICRP Publication 73. Ann ICRP 1996;26(2).

8) 医療放射線防護連絡協議会，日本医学物理学会，医療被ばく研究情報ネットワーク(J-RIME)・他．最新の国内実態調査結果に基づく診断参考レベルの設定．平成27年6月7日．http://www.radher.jp/J-RIME/report/DRLhoukokusyo.pdf

9) Riley SA. Radiation exposure from fluoroscopy during orthopedic surgical procedures. Clin Orthop Relat Res 1989;248:257-60.

10) Athwal GS, Bueno RA Jr, Wolfe SW. Radiation exposure in hand surgery:mini versus standard C-arm. J Hand Surg Am 2005;30(6):1310-6.

11) Giordano BD, Ryder S, Baumhauer JF, et al. Exposure to direct and scatter radiation with use of mini-c-arm fluoroscopy. J Bone Joint Surg Am 2007;89(5):948-52.

12) Jones DP, Robertson PA, Lunt B, et al. Radiation exposure during fluoroscopically assisted pedicle screw insertion in the lumbar spine. Spine (Phila Pa 1976) 2000;25(12):1538-41.

13) Mastrangelo G, Fedeli U, Fadda E, et al. Increased cancer risk among surgeons in an orthopaedic hospital. Occup Med (Lond) 2005;55(6):498-500.

14) Yamashita K, Higashino K, Wada K, et al. Radiation exposure to the surgeon and patient during a fluoroscopic Procedure:how high is the exposure dose? a cadaveric study. Spine (Phila Pa 1976) 2016;41(15):1254-60.

15) Yamashita K, Ikuma H, Tokashiki T, et al. Radiation exposure to the hand of a spinal interventionalist during fluoroscopically guided procedures. Asian Spine J 2017 Feb;11(1):75-81.

16) Arstein PM, Richards AM, Putney R. The risk from radiation exposure during operative X-ray screening in hand surgery. J Hand Surg Br 1994;19(3):393-6.

17) Hoffler CE, Ilyas AM. Fluoroscopic radiation exposure:are we protecting ourselves adequately? J Bone Joint Surg Am 2015;97(4):721-5.

18) Kim KY, Cho JH, Lee HK. Analysis of dose measurement other than the radiation protection during the radiographic examination. Spring plus 2014;3:250.

19) Theocharopoulos N, Perisinakis K, Damilakis J, et al. Occupational exposure from common fluoroscopic projections used in orthopaedic surgery. J Bone Joint Surg Am 2003;85(9):1698-703.

20) Jones DP, Robertson PA, Lunt B, et al. Radiation exposure during fluoroscopically assisted pedicle screw insertion in the lumbar spine. Spine (Phila Pa 1976) 2000;25:1538-41.

21) Badman BL, Rill L, Butkovich B, et al. Radiation exposure with use of the mini-C-arm for routine orthopaedic imaging procedures. J Bone Joint Surg Am 2005;87(1):13-7.

22) Barry TP. Radiation exposure to an orthopedic surgeon. Clin Orthop Relat Res 1984;182:160-4.

23) Mehlman CT, DiPasquale TG. Radiation exposure to the orthopaedic surgical team during fluoroscopy:“how far away is far enough?” J Orthop Trauma 1997;11(6):392-8.

24) Alonso JA, Shaw DL, Maxwell A, et al. Scattered radiation during fixation of hip fractures. Is distance alone enough protection? J Bone Joint Surg Br 2001;83(6):815-8.

25) Ortiz AO, Natarajan V, Gregorius DR, et al. Significantly reduced radiation exposure to operators during kyphoplasty and vertebroplasty procedures:methods and techniques. AJNR Am J Neuroradiol 2006;27(5):989-94.

26) Badman BL, Rill L, Butkovich B, et al. Radiation exposure with use of the mini-C-arm for routine orthopaedic imaging procedures. J Bone Joint Surg Am 2005;87(1):13-7.

27) Yamashita K, Higashino K, Hayashi H, et al. Pulsation and collimation during fluoroscopy to decrease radiation:a cadaver study. JB JS Open Access 2017;2(4):e0039

28) Mahajan A, Samuel S, Sasran AK, et al. Occcupational radiation exposure from C arm fluoloscopy during common orthopaedic surgical procedures and its prevention. J Clin Diagn Res 2015;9(3):RC01-4.