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

Abstract

Background The widespread adoption of minimally invasive surgery and increased use of intra‐operative fluoroscopy places surgeons and trainees at risk of cumulative occupational radiation exposure. Unfortunately, there is limited published data specific to surgeons on the potential health implications. This study aims to review current literature regarding the hazards of cumulative radiation exposure among operating theatre staff. Methods A systematic review was conducted of four databases for studies reporting on cumulative intra‐operative radiation exposure for operating theatre staff and the hazards associated with prolonged and frequent use. References from relevant studies were screened for additional texts. English language studies, controlled trials and cross‐sectional studies were included. Abstracts and full‐text studies were assessed for relevance and eligibility independently by two authors using Covidence. Results Six studies were included, with cancer being the most commonly reported long‐term health hazard possibly associated with cumulative radiation exposure. A 1.85 fold greater prevalence of all cancers and 2.9 fold greater prevalence of breast cancer was reported amongst female orthopaedic surgeons compared to a sex‐ and age‐adjusted population, but the results were not replicated amongst other surgical specialties. Multiple limitations of quantifying health risks of intra‐operative radiation exposure were identified, including identifying a dose‐effect relationship and confounders such as nulliparity and maternal age. Conclusion This article highlights the lack of robust evidence regarding the potential hazards of cumulative occupational intra‐operative radiation exposure. This study demonstrates the importance of developing standardised national radiation safety protocols for surgical colleges and subspecialties to minimise risks to operating theatre staff.

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Virtual reality training for intraoperative imaging in orthopaedic surgery: an overview of current progress and future direction

“…Patients and personnel assisting in, or performing fluoroscopically guided procedures may be exposed to high doses of radiation, with the highest dosage affecting the hands and wrist (Hafez et al, 2005;Singer, 2005). This exposure carries potential health risks, including cancer and cardiovascular disease (Chou et al, 2022;Gogos et al, 2022;Ko et al, 2018;Lai et al, 2020;Little et al, 2023). In particular, orthopaedic procedures involve the most frequent use of intraoperative fluoroscopy compared to other surgical fields (Lee et al, 2015;Visci et al, 2022).…”