Manipulation Under Anaesthetic of Children's Fractures: Use of the Image Intensifier Reduces Radiation Exposure to Patients and Theatre Personnel

Abstract

During simulated manipulation of children's forearm fractures, levels of scattered radiation from both plain radiographs and an image intensifier in different modes were measured at various sites on the surgeon, anaesthetist, radiographer, and patient both with and without recommended shielding. By using fluoroscopy in the pulsed screening mode but allowing only single pulses to occur, radiation levels could be substantially reduced to the eye, thyroid, and gonads of all those exposed. The radiographer and the anaesthetist were so far from the source and guarded by various pieces of equipment that levels were almost unrecordable. Effective dose equivalent for the surgeon using pulsed mode, based on circa six pulses per manipulation, during 100 manipulations per year, would equate to 1 microSv even in the unshielded state (< 0.1 microSv shielded), which is approximately 1/1,000 of background radiation at sea level. Because the current dose limit is 50 mSv (50,000 microSv) per year for employees, we are many orders of magnitude in the safety zone.

Radiation safety for anaesthesia providers in the orthopaedic operating room

“…Several studies in our review directly stated that because anaesthetists are exposed to such low levels of radiation they may not need to wear lead protection in the operating room [2,23,26]. The use of protective garments in the operating room is common practice among most anaesthesia providers.…”

“…Surgeons are exposed to the highest amount of radiation because of where they must stand in order to perform the operation [7,14]. Despite this fact, studies have shown that it is unlikely that orthopaedic surgeons will reach annual limits of radiation exposure under conditions of most orthopaedic practices [12,26,28]. Anaesthesia providers are consistently located further away from the radiation source compared with surgeons.…”

“…Anaesthesia providers are consistently located further away from the radiation source compared with surgeons. The data produced by the studies included in our review show that a single anaesthetist would have to be present in an unrealistic number of orthopaedic cases to reach annual occupational dose limits of radiation [1,2,4,5,7,[23][24][25][26][27].…”

“…At 1 m: 10, 15 and 5 mrem.h À1 at head, waist and feet. Manipulation under anaesthetic of children's fractures: use of the image intensifier reduces radiation exposure to patients and theatre personnel [26].…”

“…With ionising radiation produced by a standard C-arm, this is roughly equal to equivalent doses of 0.113 lSv per lateral image and 0.043 lSv per PA image [16]. Keenan et al [26] found even lower levels in a simulated manipulation of a child's forearm using a manikin with scatter properties similar to human tissue. Scatter was measured both with and without shielding at the position of the anaesthetist at the head of the table.…”