The hidden risk of ionizing radiation in the operating room: a survey among 258 orthopaedic surgeons in Brazil

Abstract

Background: This study aims to assess orthopaedic surgeon knowledge in Brazil about ionizing radiation and its health implications on surgical teams and patients. Methods: A 15-question survey on theoretical and practical concepts of ionizing radiation was administered during the 23rd Brazilian Orthopaedic Trauma Association annual meeting. The survey addressed issues within orthopedic surgery, such as radiation safety concepts, protection, exposure, as well as the participant gender. Participants were either orthopedic surgeons or orthopedic surgery residents working at institutions in Brazil. Results: One thousand surveys were distributed at the moment of the meeting registration, and 258 were answered completely (25.8% response rate). Only 5.8% of participants used basic radiation protection equipment; 47.3% used a dosimeter; 2.7% reached the annual maximum permissible radiation dose; 10.5% knew the period of increased risk to fetal gestation; 5.8% knew the maximum permissible radiation dose during pregnancy; 58.5% knew that the hands, eyes, and thyroid are the most exposed areas and at greater risk of radiation-related lesions; 25.2% knew the safe distance from a radiation-emitting tube is 3 m or more; 44.2% knew the safest positioning of the radiation-emitting tube; 25.2% knew that smaller tubes emit greater radiation at the entrance dose to magnify the image; and 55.4% knew that the surgery team receives more scattered radiation in surgical procedures performed on obese patients. Conclusion: This study revealed inadequate theoretical and practical knowledge about radiation exposure among orthopaedic surgeons in Brazil. Only a minority of orthopaedic surgeons used basic radiation protection equipment. No significant differences in knowledge were found when comparing all orthopedic surgery specialties. Our findings indicate an urgent need for education to increase knowledge among orthopaedic surgeons about the hazards of ionizing radiation. Personal protection and implementation of the ALARA (as low as reasonably achievable) protocol in daily practice are important behaviors to prevent the harmful effects of ionizing radiation.

Radiation in orthopaedics (RIO) study: a national survey of UK orthopaedic surgeons

“…This study is one of largest reported surveys undertaken to assess radiation safety knowledge and principles for orthopaedic surgeons. The findings are supported by other studies in the literature, [5][6][7][8][9][10][11][12][13][14][15][16][17] the majority of which were smaller local or regional surveys with less than 90 orthopaedic surgeon responses. [5][6][7][8][9][10][11] Overall, they showed limited radiation safety knowledge, lack of formalised training and poor usage of radiation protective equipment.…”

“…A national survey of 258 Brazilian orthopaedic surgeons also concluded there was inadequate theoretical and practical knowledge regarding radiation exposure with only a minority using basic radiation protection equipment. 14 Fidan et al 15 (2019) analysed 180 surgeon's responses and highlighted lack of radiation safety knowledge with only 12% having received training. Interestingly, only 68% wore lead aprons and 52% To our knowledge, this study is the largest European survey in terms of total responses and one of the largest reported internationally.…”

“…Other studies have also shown surgeon's lack of knowledge in labelling or correctly positioning such equipment. 7,8,14 Despite its regular use in orthopaedic procedures, many surgeons are not familiar with basic components of the machine, perhaps relying on a radiographer to know how to use the machine correctly. Junior radiographers are frequently used in orthopaedic theatres with studies potentially showing higher overall radiation doses being administered by less experienced radiographers.…”

“…These findings are supported by other studies showing poor uptake of protective equipment by orthopaedic surgeons. [5][6][7][8][9][10][12][13][14][15][16][17] The importance of such equipment in minimising ionising radiation exposure is key due to well-documented carcinogenic risks of cumulative exposure. Surgeon's hands, eyes and thyroid are especially at risk due to their potential close proximity to the X-ray beam and increased radiosensitivity.…”

Awareness of Theatre Team to Radiation Risk From C-Arm During Surgical Procedures: A Case Study of University of Calabar Teaching Hospital in Nigeria

“…In this study as observed in table 5 most of the respondents (83.67%) are aware of the harmful effects of radiation: Surgeons (100%), Anesthesiologists (60%), Theatre Nurses (66%) and Radiographers (100%). This awareness rate is high when compared to that found among a group of theatre team in Brazil (55.4%) (Pires et al, 2020). Though the respondents are aware of the harmful effects of radiation, the study however shows that they have an average level of awareness to radiation protection or safety measures with exception of Radiographers: Surgeons (58.8%), Anesthesiologists (50%), Theatre Nurses (33.3%), and Radiographers (100%).…”