Estimation of radiation doses to patients and surgeons from various fluoroscopically guided orthopaedic surgeries

Abstract

In this study, a mathematical method was used to estimate the entrance surface dose (ESD) to the patient and the scattered dose (Ds) to the operating surgeon during various fluoroscopically guided surgical orthopaedic procedures. For 204 patients, the procedure type, the fluoroscopy time and the highest tube potential and current values observed during fluoroscopy were recorded. For the most often performed procedures (intramedullary nailing of peritrochanteric fractures, open reduction and internal fixation of malleolar fractures and intramedullary nailing of diaphyseal fractures of the femur), the respective mean fluoroscopy times were 3.2, 1.5 and 6.3 min while the estimated mean ESDs were 183, 21 and 331 mGy, respectively. The estimated Ds rates for the hands, chest, thyroid, eyes, gonads and legs of the operating surgeon were on average to 0.103, 0.023, 0.013, 0.012, 0.066 and 0.045 mGy min(-1), respectively, and compare well with the literature. The mathematical estimation of doses cannot replace actual measurements; however, it can be used for a preliminary assessment of the radiation dose levels during various surgical procedures, so that the operator, the surgeon and the rest of the medical staff involved could be aware of the associated radiation risk and the radiation protection measures required.

Does Fluoroscopy Improve Acetabular Component Placement in Total Hip Arthroplasty?

“…While the use of fluoroscopy during the surgery did not prolong the case, setup and take down of the C-arm, and how that figures into total time in the operating room and potential costs associated with its use were not analyzed. The radiation exposure to the patient and surgeon was not recorded during this study, but these data were reported for numerous orthopaedic procedures that use fluoroscopy [20]. We did not analyze the outcomes for the senior authors individually.…”

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

“…In the next step, only studies where effective radiation to the surgeon was directly measured in the operating theatre were further considered for this review. Studies using indirect measurements or formulas to back calculate surgeon exposure [14][15][16][17][18][19][20][21][22][23][24] as well as studies measuring radiation exposure in Gray only were not further reviewed because of the problem of comparability [25][26][27][28][29][30][31].…”

Reduction of Radiation Exposure From C-Arm Fluoroscopy During Orthopaedic Trauma Operations With Introduction of Real-Time Dosimetry

“…[1][2][3][4][5] Despite this increase in use and the subsequent increase in radiation exposure to the operative team and patient, the long-term effects of exposure to low-dose ionizing radiation remain largely unknown. 4,[6][7][8] There exists strong evidence for an increase in cancer risk for chronic doses greater than 100 mSv and reasonable evidence for an increase in cancer risk at chronic doses above 50 mSv.…”