Methods for Reducing Intraoperative Breast Radiation Exposure of Orthopaedic Surgeons.

Background: Standard lead aprons and vests do not adequately shield the most common breast cancer site, the upper outer quadrant (UOQ), from intraoperative radiation. The purpose of the present study was to determine if lead sleeves, wings, and/or axillary supplements decreased intraoperative radiation exposure of the UOQ of the breast.

Methods: An anthropomorphic torso phantom (simulating the female surgeon) was placed adjacent to a standard operating room table. Dosimeters were placed bilaterally over the UOQ of the breast. Scatter radiation dose equivalent rates (mrem/hr) were measured during continuous fluoroscopy of a pelvic phantom (simulating the patient). Five protection configurations (no lead; lead vest; and vest with sleeves, wings, and axillary supplements), 2 surgeon positions (facing the table and perpendicular to the table), and 2 C-arm positions (anteroposterior and cross-table lateral projection) were tested. The t test was utilized with a Bonferroni correction for multiple t tests.

Results: Lead sleeves and axillary supplements decreased intraoperative radiation exposure to the UOQ of the breast when compared with a well-fitted standard lead vest alone (p < 0.01) across all surgeon and C-arm positions. The addition of wings decreased radiation exposure to a lesser extent than sleeves or axillary supplements, and the difference when compared with the lead vest alone did not reach significance (p = 0.29). Breast radiation exposure in the C-arm cross-table lateral projection was highest across all testing.

Conclusions: The UOQ of the breast is not adequately protected by standard lead vests alone or vests with the addition of wings. Axillary supplements and sleeves improved protection of the breast.

Clinical Relevance: Modifications of lead protective vests may improve intraoperative breast radiation protection.