Radiation Exposure During Internal Fixation of Extracapsular Femoral Neck Fractures by Today's Trainees

Abstract

The use of intraoperative fluoroscopy screening is often crucial to the success of fracture fixation in orthopaedic trauma surgery. Given the possible link to carcinogenesis as well as other complications, limited exposure to and protection from radiation is mandated both for staff and patients. Governing bodies in several countries, including the UK, dictate that exposures be kept as low as reasonably practicable.

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

“…Studies have also demonstrated that surgical trainees and junior consultants are at a greater intraoperative radiation risk compared to senior consultants, receiving higher effective doses of radiation associated with longer fluoroscopy screening times. 21,23,24,30 As of 2021, completion of a radiation safety course is a mandatory requirement of application to the Australian Orthopaedic Association (AOA) surgical training programme in Australia and New Zealand. 31 The use of PPE such as lead shielding has been shown to significantly reduce radiation exposure when used correctly and routinely, however operating staff compliance with thyroid shields and leaded glasses is inconsistent.…”

“…Recent studies have extrapolated the amount of intra‐operative radiation absorbed by operating theatre staff using recorded DAP values, taking into account variables including fluoroscopy screening time, distance from the patient, patient size and positioning of radiographic equipment 21 . The median effective radiation dose received by the primary operating surgeon wearing a lead apron during a dynamic hip screw (DHS) procedure has been measured between 0.28 to 2.5 mSv 21–24 . Procedures with higher levels of radiation exposure include lumbar spine fusion, balloon angioplasty and endovascular aneurysm repair (EVAR) with median effective doses of 1.37, 4.7 and 27 mSv respectively 22,25,26 .…”

“…There are currently no nationally endorsed radiation safety guidelines specific to surgeons and surgical trainees in Australia. Studies have also demonstrated that surgical trainees and junior consultants are at a greater intra‐operative radiation risk compared to senior consultants, receiving higher effective doses of radiation associated with longer fluoroscopy screening times 21,23,24,30 . As of 2021, completion of a radiation safety course is a mandatory requirement of application to the Australian Orthopaedic Association (AOA) surgical training programme in Australia and New Zealand 31…”

“…Intra‐operative radiation doses received by patients during common procedures are routinely recorded as a dose area product (DAP). Recent studies have extrapolated the amount of intra‐operative radiation absorbed by operating theatre staff using recorded DAP values, taking into account variables including fluoroscopy screening time, distance from the patient, patient size and positioning of radiographic equipment 21 . The median effective radiation dose received by the primary operating surgeon wearing a lead apron during a dynamic hip screw (DHS) procedure has been measured between 0.28 to 2.5 mSv 21–24 .…”

“…21 The median effective radiation dose received by the primary operating surgeon wearing a lead apron during a dynamic hip screw (DHS) procedure has been measured between 0.28 to 2.5 mSv. [21][22][23][24] Procedures with higher levels of radiation exposure include lumbar spine fusion, balloon angioplasty and endovascular aneurysm repair (EVAR) with median effective doses of 1.37, 4.7 and 27 mSv respectively. 22,25,26 Despite the recent focus into quantifying radiation exposure amongst operating theatre staff, there is limited epidemiological data available regarding the long-term effects of intraoperative radiation exposure.…”