ABSTRACT

Objectives:

Radiation exposure is one of the important known risk factors for thyroid cancers. The most common type of cancer in individuals exposed to radiation is papillary thyroid cancer. Papillary thyroid cancer requires an exposure of at least 5-10 years and an average of 20 miliSievert per year.

Materials and Methods:

Radiological examinations performed in the operating room create intense radiation exposure on healthcare personnel. Fifty-eight health personnel randomly selected working in the Ankara University Faculty of Medicine operating room and who were predicted to have radiation exposure, were given thyroid ultrasonography for thyroid nodule and malignancy control.

Results:

Ultrasonographic imaging was normal in 28 of the participants. In 3 of the remaining 30 participants, thyroiditis was detected. Nodules of <5 mm in size were detected in 15 participants, and they were included in the follow-up program at 6-month intervals. Nodules measuring >1 cm were observed in 5 of 12 participants, and nodules measuring 5-10 mm were observed in 7 of 12 participants. According to American Thyroid Association (ATA) classification criteria, fine needle aspiration biopsy of 5 highly suspicious and 2 moderately suspicious nodules was performed by the same surgeon, accompanied by onsite cytological evaluation. Cytology results were reported as Bethesda Type 6 in 3, Type 5 in 1, Type 3 in 1 and Type 1 in 2 cases.

Conclusion:

Considering the working conditions, operating room workers experience more radiation exposure than the general population and the other healthcare workers. While the rate of detection of malignancy in thyroid nodules in the general population is 5%, cancer was detected in 4 (14.8%) out of 27 healthcare workers, which are evaluated according to ATA classification, in our study, which is approximately 3 times the rate of the general population. Considering that thyroid nodules and cancer may develop over the years after cumulative exposure, we believe that although there is no screening program for thyroid cancer, it is necessary to screen for thyroid cancer with ultrasonography in those working in areas with high radiation exposure.

Keywords: Thyroid Cancer, Radiation Exposure, Operating Room Staff, Screening

References

Filetti S, Durante C, Hartl D, et al. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2019;30:1856-1883.

Iglesias ML, Schmidt A, Ghuzlan AA, et al. Radiation exposure and thyroid cancer: A review. Archives of Endocrinology and Metabolism. 2017;61:180-187.

Veiga LHS, Holmberg E, Anderson H, et al. Thyroid cancer after childhood exposure to external radiation: An updated pooled analysis of 12 studies. Radiation Research. 2016;185:473-484.

Nikiforova MN, Ciampi R, Salvatore G, et al. Low prevalence of BRAF mutations in radiation-induced thyroid tumors in contrast to sporadic papillary carcinomas. Cancer Letters. 2004;209:1-6.

Abend M, Pfeiffer RM, Port M, et al. Utility of gene expression studies in relation to radiation exposure and clinical outcomes: thyroid cancer in the Ukrainian-American cohort and late health effects in a MAYAK worker cohort. International Journal of Radiation Biology. Published online 2020.

Abend M, Pfeiffer RM, Ruf C, et al. Iodine-131 dose dependent gene expression in thyroid cancers and corresponding normal tissues following the chernobyl accident. PLoS ONE. 2012;7.

Robatjazi M, Dareyni A, Baghani HR, et al. Investigation of radiation dose around C-arm fluoroscopy and relevant cancer risk to operating room staff. Radiation and Environmental Biophysics. 2022;61:301-307.

Albi E, Cataldi S, Lazzarini A, et al. Radiation and thyroid cancer. International Journal of Molecular Sciences. 2017;18(5).

Bratschitsch G, Leitner L, Stücklschweiger G, et al. Radiation Exposure of Patient and Operating Room Personnel by Fluoroscopy and Navigation during Spinal Surgery. Scientific Reports. 2019;9.

Wang J X, Boice Jr J D, Li B X, et al. Cancer amoung medical diagnostic x-ray workers in China. J Natl Cancer Inst. 1988;80:344-350.

Radiation Exposure and Thyroid Cancer Development in Operating Room Staff

ABSTRACT

References