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

Abstract

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.

What we know about intra‐operative radiation exposure and hazards to operating theatre staff: A systematic review

“…Radiation damage is divided into deterministic and stochastic effects. Deterministic effects are those that occur after a certain threshold of high‐energy photons are absorbed by tissues and have a clear relationship between exposure and effect, such as radiation burns, infertility and death 16–18 . Stochastic effects are those that appear years after exposure, presumably secondary to cumulative radiation exposure over a prolonged period of time such as cancer 16,17,19 .…”

“…[16][17][18] Stochastic effects are those that appear years after exposure, presumably secondary to cumulative radiation exposure over a prolonged period of time such as cancer. 16,17,19 There are notable challenges translating measured doses of intraoperative radiation into stochastic effects, including the significant delay between radiation exposure and onset of disease and multifactorial nature of carcinogenesis. 2,20 Consequently, there is minimal published data available quantifying dose-response of occupational intra-operative radiation exposure and incidence of cancer.…”

Visualising the Future of Orthopaedic Surgery: A Novel Application of Wireless Smart Glasses to Visualise Intraoperative Imaging

“…Intraoperative radiation exposure is another key occupational hazard to orthopaedic surgeons [13,14].…”

Awareness of Radiation Hazard in Orthopaedic Residents Surgeon in a Central India

“…In everyday use, thyroid gland shield special gloves are seldom used. 3 In general, orthopedic surgeons, mostly residents, are unaware of their radiation exposure. As a result, the aim of this research is to quantify the annual radiation exposure of residents employed in a medical college (tertiary care hospital) and equate it to international standards.…”

“…Such type of radiation exposure is vulnerable to both surgeon and circulating staff. 3 As per the Inverse square theorem, the intensity of X-rays (which can be defined as photons per unit area) is inversely proportional to the square of the distance from the source due to which the impact of direct fluoroscopy beam exposure at 2meters is relatively small, but scattered radiation remains a possibility. (Dewey et al 2005).…”