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

Abstract

Objectives: Orthopaedic surgeons have a responsibility to minimise risks of ionising radiation to patients, themselves and staff. This study aims to establish the understanding of radiation practice, legislation and risk by orthopaedic surgeons. Methods: A nationwide online survey of UK-based orthopaedic surgeons was conducted. Participants answered eighteen multiple-choice questions assessing level of radiation safety training, basic principles/knowledge of ionising radiation, relevant legislation and operating practice. Results: A total of 406 surgeons completed the survey. 92% reported using intra operative ionising radiation at least once per week. 38% received no formal training on radiation safety. Knowledge of basic principles of radiation and legislation was limited. There was variable knowledge when labelling an image intensifier machine and choosing its safest orientation. Poor uptake of radiation protection equipment was noted. Only 19% agreed they had adequate training in ionising radiation safety and 27% reported receiving adequate training in equipment emitting ionising radiation in the operating theatre. Conclusion: Many orthopaedic surgeons in the UK do not believe they are adequately trained in radiation safety. There is a deficiency amongst practicing surgeons in basic knowledge, relevant legislation and practicalities of the use of ionising radiation in the operating room. This could potentially put patients and healthcare professionals at additional risk. We recommend that a standardised national training programme on the basic principles and safety of ionising radiation is implemented for all practicing orthopaedic surgeons. Advances in knowledge: This paper is the first UK national survey amongst orthopaedic surgeons and is one of the largest reported internationally.

Knowledge and practice of radiation protection in the operating theater among orthopedic surgeons

“…Similarly, less than half of the surgeons had knowledge that, in lateral imaging, they should be standing on the opposite side of the x-ray tube since the highest rate of scatter is produced between the x-ray tube and the patient. 14 The correct response rate is comparable to a study conducted in the UK by Raza et al 19 in which 55% of the orthopedic surgeons answered correctly on a similar question. Training the surgeons on the correct position of the x-ray tube is essential in reducing their radiation exposure.…”

“…Similar trends of radiation protective equipment were described by Tuncer et al in which 85% of the orthopedic surgeons reported using lead apron, 5% lead glasses, and a higher percent of 70% using thyroid shield. 20 Raza et al 19 also reported a poor use of the thyroid shield and lead glasses in their study. Chronic radiation exposure has shown to have a damaging effect on the eye in the form of cataracts, 9 however, wearing lead glasses will decrease radiation exposure to the eye by 90%.…”

“…in which 85% of the orthopedic surgeons reported using lead apron, 5% lead glasses, and a higher percent of 70% using thyroid shield 20 . Raza et al 19 . also reported a poor use of the thyroid shield and lead glasses in their study.…”