Reverse Total Shoulder Arthroplasty for Primary Glenohumeral Osteoarthritis in Patients with a Biconcave Glenoid

TLDR

Lead glasses are recommended but rarely used, yet ocular radiation exposure can cause cataracts and regulatory limits are tightening. The study measured surgeon eye dose with anthropomorphic phantoms during 16 common pelvic and hip fluoroscopic views, comparing protected versus unprotected lens exposure. Lead glasses reduced surgeon eye dose by about 90% (tenfold), but exposure varied widely across views, enabling up to ten times more patients before exceeding the 20 mSv annual eye dose limit.

Abstract

Background: Despite recommendations to do so, few orthopaedists wear leaded glasses when performing operative fluoroscopy. Radiation exposure to the ocular lens causes cataracts, and regulatory limits for maximum annual occupational exposure to the eye continue to be revised downward. Methods: Using anthropomorphic patient and surgeon phantoms, radiation dose at the surgeon phantom's lens was measured with and without leaded glasses during fluoroscopic acquisition of sixteen common pelvic and hip views. The magnitude of lens dose reduction from leaded glasses was calculated by dividing the unprotected dose by the dose measured behind leaded glasses. Results: On average, the use of leaded glasses reduced radiation to the surgeon phantom's eye by tenfold, a 90% reduction in dose. However, there was widespread variation in the amount of radiation that reached the phantom surgeon's eye among the various radiographic projections we studied. Without leaded glasses, the dose measured at the surgeon's lens varied more than 250-fold among these sixteen different views. Conclusions: In addition to protecting the surgeon's eye from the deleterious effects of radiation, the use of leaded glasses could permit an orthopaedist to perform fluoroscopic views on up to ten times more patients before reaching the annual dose limit of 20 mSv of radiation to the eye recommended by the International Commission on Radiological Protection. Personal safety and adherence to limits of occupational radiation exposure should compel orthopaedists to wear leaded glasses for fluoroscopic procedures if other protective barriers are not in use. Clinical Relevance: Leaded glasses are a powerful tool for reducing the orthopaedic surgeon's lens exposure to radiation during acquisition of common intraoperative fluoroscopic views.