Določanje tipičnih vrednosti doz pri intraoperativnih rentgenskih posegih v UKC Ljubljana - retrospektivna analiza : magistrsko delo

Stare, Jakob (author), Mekiš, Nejc (mentor), Žager Marciuš, Valerija (reviewer)

Uvod: Diagnostične referenčne ravni so pomembno orodje za spremljanje in optimizacijo izpostavljenosti pacientov ionizirajočemu sevanju. Razvoj intraoperativnih rentgenskih sistemov zahteva redno spremljanje dozimetričnih kazalnikov in določanje tipičnih vrednosti za posamezne posege. Namen: Namen raziskave je bil določiti tipične vrednosti produkta doze in površine (DAP) pri izbranih intraoperativnih rentgenskih posegih v Univerzitetnem kliničnem centru Ljubljana ter ugotoviti razlike med uporabljenimi rentgenskimi aparati. Metode dela: Izvedena je bila retrospektivna raziskava s sekundarno analizo podatkov 495 pacientov iz obdobja od januarja do junija 2025. Analizirani so bili podatki o telesni masi pacientov, DAP in času diaskopije pri vstavitvi proksimalnega stegneničnega žeblja (PFN), parcialne endoproteze kolka (PEP), proksimalnega nadlahtničnega žeblja (PHN), golenskega žeblja (ETN), fiksaciji hrbtenice, globoki možganski stimulaciji (DBS) ter navigacijsko vodeni fiksaciji hrbtenice. Tipičnih vrednosti DAP so bile določene z mediano. Razlike med aparati so bile statistično analizirane pri stopnji značilnosti p < 0,05. Rezultati: Tipične vrednosti DAP so znašale 67,33 µGym² pri PFN, 11,33 µGym² pri PEP, 16,00 µGym² pri PHN, 17,88 µGym² pri ETN, 314,51 µGym² pri fiksaciji hrbtenice, 213,42 µGym² pri DBS in 186,69 µGym² pri navigacijsko vodeni fiksaciji hrbtenice. Pri PFN (p = 0,965), ETN (p = 0,615) in fiksaciji hrbtenice (p = 0,605) statistično značilnih razlik v DAP med aparati ni bilo, medtem ko so bile pri PEP (p < 0,001) in PHN (p < 0,001) ugotovljene statistično značilne razlike. V primerjavi s predhodno raziskavo v UKC Ljubljana iz leta 2018 so bile tipične vrednosti pri PFN, PEP in PHN nižje za 9,0 %, 33,4 % oziroma 54,3 %, medtem ko je bila pri fiksaciji hrbtenice vrednost za 97,8 % višja. Razprava in zaključek: Ugotovljene tipične vrednosti kažejo na velike razlike v izpostavljenosti pacientov med posameznimi vrstami intraoperativnih rentgenskih posegov, zato je njihovo ločeno spremljanje pomembno za optimizacijo radiološke zaščite. Pri večini primerjanih posegov med aparati ni bilo statistično značilnih razlik v DAP, medtem ko ugotovljene razlike pri PEP in PHN kažejo na potrebo po nadaljnjem spremljanju. Prvi sistematično zbrani podatki za DBS in navigacijsko vodeno fiksacijo hrbtenice z uporabo sistema O-arm predstavljajo izhodišče za nadaljnje spremljanje.

• Language: Slovenian
• Keywords: magistrska dela, radiološka tehnologija, diagnostične referenčne ravni, produkt doze in površine, intraoperativna diaskopija
• Work type: Master's thesis/paper
• Typology: 2.09 - Master's Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [J.Stare]
• Year: 2026
• Number of pages: X, 53 str., [4] str. pril.
• PID: 20.500.12556/RUL-188175
• UDC: 616-07
• COBISS.SI-ID: 291727875
• Publication date in RUL: 19.09.2026

Secondary language

• Language: English
• Title: Establishment of typical radiation dose values for intraoperative x-ray procedures at the University medical centre Ljubljana: a retrospective analysis : master thesis

Abstract

Introduction: Diagnostic reference levels are an important tool for monitoring and optimizing patient exposure to ionizing radiation. The development of intraoperative X-ray systems requires regular monitoring of dosimetric indicators and the establishment of typical values for individual procedures. Purpose: The purpose of this study was to determine typical dose-area product (DAP) values for selected intraoperative X-ray procedures at the University Medical Centre Ljubljana and to assess differences between the X-ray systems used. Methods: A retrospective study with secondary data analysis was conducted, including data from 495 patients collected between January and June 2025. Patient body weight, DAP, and fluoroscopy time were analysed for proximal femoral nail (PFN) insertion, partial hip arthroplasty (PEP), proximal humeral nail (PHN) insertion, tibial nail (ETN) insertion, spinal fixation, deep brain stimulation (DBS), and guided spinal fixation. Typical DAP values were determined using the median. Differences between X-ray systems were statistically analysed at a significance level of p < 0.05. Results: Typical DAP values were 67.33 µGym² for PFN, 11.33 µGym² for PEP, 16.00 µGym² for PHN, 17.88 µGym² for ETN, 314.51 µGym² for spinal fixation, 213.42 µGym² for DBS, and 186.69 µGym² for guided spinal fixation. No statistically significant differences in DAP between X-ray systems were observed for PFN (p = 0.965), ETN (p = 0.615), or spinal fixation (p = 0.605), whereas statistically significant differences were found for PEP (p < 0.001) and PHN (p < 0.001). Compared with a previous study conducted at the University Medical Centre Ljubljana in 2018, typical values for PFN, PEP, and PHN were 9.0%, 33.4%, and 54.3% lower, respectively, whereas the value for spinal fixation was 97.8% higher. Discussion and conclusion: The established typical values demonstrate substantial differences in patient exposure among different types of intraoperative X-ray procedures, highlighting the importance of procedure-specific monitoring for the optimization of radiation protection. For most procedures, no statistically significant differences in DAP were observed between X-ray systems, while the differences identified for PEP and PHN indicate the need for continued monitoring. The first systematically collected data for DBS and spinal fixation using the O-arm system provide a basis for further monitoring.

• Keywords: master's theses, radiologic technology, diagnostic reference levels, dose-area product, intraoperative fluoroscopy