Emission of radiation in the orthopaedic operation room: A comprehensive review

Abstract

Introduction Ionising radiation is a constant risk to exposed workers. Recently, it was shown that the incidence of malignant diseases was increased in an orthopaedic hospital among exposed personnel. However, the surgeons are often ill-informed about the utilisation of the fluoroscopic units, which leads to unnecessary exposure to radiation, for both the operating team as well as the patients. This review article aims to give a comprehensive review on the exposure of staff in the orthopaedic operation room and to develop advises to reduce the risk deriving from ionising radiation. Material and methods A comprehensive review of the published literature associated to intra-operative radiation in orthopaedics was performed. The electronic platform, PubMed was used to search for relevant studies. The keywords used included 'intra-operative radiation', 'radiation orthopaedics' and 'radiation'. The search was performed in English and German. The reference list of identified articles was crosschecked to identify further articles that contributed to the topic. Results Using the above mentioned inclusion criteria, 30 articles were identified that contributed to the topic. Intraoperative fluoroscopy increases the radiation dose distinctly. Especially, the scatter radiation leads to increasing doses for the surgical team. Scatter radiation occurs while passing through the patient's body. Only 2% of the emitted photons actually reach the image intensifier. On the contrary, 10%-20% of the photons are scattered. Conclusion Intra-operative fluoroscopy is a precious and essential tool for orthopaedic operations. If the surgical staff follow the principles (shielding, ALARA, etc.), the radiation exposure in the operating room can be reduced significantly. New technologies will hopefully help in the future to further reduce the emission of radiation.

The Great Unknown—A systematic literature review about risk associated with intraoperative imaging during orthopaedic surgeries

“…During an additional crosscheck of citations in Google scholar, one additional literature review was identified [1]. Finally, 34 publications matched the eligibility criteria (Table 3).…”

“…Only a few reviews reporting about radiation exposure of surgeons were found during the literature search [1,2,[32][33][34][35][36][37][38][39][40][41]. Of the 12 reviews, 4 were identified as appropriate.…”

“…Of the emitted photons, only 2% reach the image intensifier, 10-20% are scattered, and the rest are absorbed in the operative field. Primary radiation occurs if the surgeon's hand or other body part is in the primary beam and the resulting radiation exposure is much higher [1,2].…”

Radiation exposure and fluoroscopically-guided interventional procedures among orthopedic surgeons in South Korea

“…Fluoroscopic procedures have been beneficial for patients undergoing orthopedic surgery because these minimally invasive procedures provide better direct visualization for soft tissue dissection, spare blood supply, and result in fewer complications than open surgeries [3,4]. However, during the fluoroscopic procedures, the surgeons may be exposed to the primary beam and scattered radiation [2,5]. As the use of fluoroscopy is continuously increasing in orthopedic surgery and orthopedic surgeons are often closely exposed to the radiation source during operations, they are considered a high-risk group of occupational radiation exposure [6][7][8][9][10].…”

Letter to the Editor (June 27, 2017) concerning the paper “Factors affecting exposure level for medical staff during orthopedic procedures under fluoroscopic control”

“…Richter i wsp. wskazują, że odwracanie ramienia C pozwala na uzyskanie większej swobody ruchów operatora w polu operacyjnym [15]. Z doświadczenia autorki niniejszego listu jako audytora wewnętrznego wynika, że często takie ustawienie lampy rentgenowskiej jest stosowane przez lekarzy w celu geometrycznego powiększenia obrazu.…”