Radiation Exposure to the Orthopaedic Surgeon

Sanders, R. L.; Koval, Kenneth J.; DiPasquale, Thomas

doi:10.1097/00005131-199212000-00026

Cited by 13 publications

(13 citation statements)

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“…(110) Procedures such as intramedullary nailing of tibial and femoral fractures require an average procedural time of 1-10 min, resulting in an average unprotected dose rate to the surgeon of 0.128, 0.015, and 0.028 mSv/min for hands, eyes, and chest, respectively. These values correspond to doses of 0.44, 0.05, and 0.10 mSv/case (Sanders et al, 1993;Mü ller et al, 1998;Tsalafoutas et al, 2008). The average unprotected thyroid dose rate during such procedures is 0.016 mSv/min or 0.06 mSv/case for a fluoroscopy time of 3.2 min/case (Tsalafoutas et al, 2008).…”

Section: Levels Of Radiation Dosementioning

confidence: 99%

Radiological Protection in Fluoroscopically Guided Procedures Performed Outside the Imaging Department

Rehani¹,

Ciraj-Bjelac²,

Vañó³

et al. 2010

Ann ICRP

243

137

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An increasing number of medical specialists are using fluoroscopy outside imaging departments, but there has been general neglect of radiological protection coverage of fluoroscopy machines used outside imaging departments. Lack of radiological protection training of those working with fluoroscopy outside imaging departments can increase the radiation risk to workers and patients. Procedures such as endovascular aneurysm repair, renal angioplasty, iliac angioplasty, ureteric stent placement, therapeutic endoscopic retrograde cholangio-pancreatography,and bile duct stenting and drainage have the potential to impart skin doses exceeding Gy. Although tissue reactions among patients and workers from fluoroscopy procedures have, to date, only been reported in interventional radiology and cardiology,the level of fluoroscopy use outside imaging departments creates potential for such injuries.A brief account of the health effects of ionising radiation and protection principles is presented in Section 2. Section 3 deals with general aspects of the protection of workers and patients that are common to all, whereas specific aspects are covered in Section 4 for vascular surgery, urology, orthopaedic surgery, obstetrics and gynaecology,gastroenterology and hepatobiliary system, and anaesthetics and pain management.Although sentinel lymph node biopsy involves the use of radio-isotopic methods rather than fluoroscopy, performance of this procedure in operating theatres is covered in this report as it is unlikely that this topic will be addressed in another ICRP publication in coming years. Information on radiation dose levels to patients and workers, and dose management is presented for each speciality.

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Section: Levels Of Radiation Dosementioning

confidence: 99%

Radiological Protection in Fluoroscopically Guided Procedures Performed Outside the Imaging Department

Rehani¹,

Ciraj-Bjelac²,

Vañó³

et al. 2010

Ann ICRP

243

137

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“…There is little orthopedic literature on the role of hand dominance and radiation exposure. Saunders et al 11 in 1993 looked at radiation exposure in 65 live orthopedic trauma cases, mostly lower extremity, where participants wore ring dosimeters on both wrists, and found no correlation to surgeon's hand dominance. However, Bahara et al 3 pointed out that in hand surgery, one cannot distance themselves from the radiation beam as easily.…”

Section: Discussionmentioning

confidence: 99%

Radiation Exposure and Hand Dominance Using Mini C-Arm Fluoroscopy in Hand Surgery

Fuller

Wongworawat

Riedel

2016

Hand (New York, N,Y.)

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The results do not allow comparison of radiation exposure related to hand dominance. Assuming worst-case scenario: each ring measured 29 mrem (just below the threshold), the surgeon's hands experienced 2.7 mrem per case. This would allow a hand surgeon to perform 18 391 cases per year before exceeding the allowable annual hand exposure limit of 50 000 mrem set by the National Council of Radiation Protection and Measurements and International Commission on Radiological Protection.

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“…During placement of interlocking screws in femoral or tibial nailing the person standing next to the fluoroscopy C-arm receives significantly more radiation than circulating staff. Distal targeting methods can reduce fluoroscopy exposure, as can avoidance of direct handling of the C-arm, placing hands in the operative field during screening, and unnecessary screening (Rampersaud et al 2000, Sanders et al 1993). The scattered radiation dose distribution is non-uniform, making it hard to record the dose absorbed by the eyes/forehead, neck/thyroid and hands of operating theatre staff.…”

Section: Orthopaedic Surgery and Radiation Riskmentioning

confidence: 99%

“…According to the ICRP the maximum annual permissible upper dose limit is 20mSv for the body, 150mSv for thyroid or eyes and 500mSv for hands (International Commission for Radiation Protection, 1990 publication 60). Orthopaedic surgeons face a greater risk to hands than radiographers and cardiologists (Hafez et al 2005, Jones & Stoddart 1998, Sanders et al 1993). The hands, eyes and thyroid glands are susceptible to radiation exposure among medical staff due to their proximity to primary radiation.…”

Section: Responsibility Of the Employermentioning

confidence: 99%

Radiation risk amongst orthopaedic surgeons – Do we know the risk?

Gowda

Mitchell

Abouel-Enin

et al. 2018

Journal of Perioperative Practice

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Radiation risk amongst orthopaedic surgeons and theatre personnel is increasing with increased use of fluoroscopy imaging. Increased radiation risk has been shown to be associated with an increased risk of malignancies, ocular and thyroid disorders. Very high exposures have been reported in spinal surgery and during intra-medullary nailing. With an increase in modern and percutaneous methods, the use of intra-operative fluoroscopy has increased as well. The aim of this article was to review the available evidence of radiation risk amongst healthcare personnel. A systematic search was carried out in PubMED, CINAHL and Cochrane on intra-operative radiation in trauma and orthopaedic operating room. Inclusion criteria were clinical studies and systematic reviews reporting on radiation exposure, fluoroscopy time and references to specific safety guidelines. This article highlights the safety aspects of radiation protection and harmful effects of radiation during orthopaedic procedures. The responsibility to minimise radiation exposure in operating theatre lies with the team within the operating room.

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Radiation Exposure to the Orthopaedic Surgeon

Cited by 13 publications

References 0 publications

Radiological Protection in Fluoroscopically Guided Procedures Performed Outside the Imaging Department

Radiological Protection in Fluoroscopically Guided Procedures Performed Outside the Imaging Department

Radiation Exposure and Hand Dominance Using Mini C-Arm Fluoroscopy in Hand Surgery

Radiation risk amongst orthopaedic surgeons – Do we know the risk?

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