Radiation Safety Knowledge and Practices: Is the Indian Orthopaedic Community Well-informed?

Abstract

Background In spite of frequent exposure to radiation, orthopaedic surgeons lack knowledge about radiation safety and do not comply with safety practices. We surveyed orthopaedic trainees and consultants in India to determine their knowledge and practices regarding radiation safety. Methods A questionnaire with 16 multiple choice questions was sent out using Google forms. We included practicing orthopaedic surgeons (consultants), fellows and trainees pursuing DNB, MS and D. Ortho courses across India. ResultsWe received 439/700 responses (62.7% response rate) from 233 (53.1%) consultants and 206 (46.9%) trainees. Only 71 (16.2%) were aware of the ALARA (As Low As Reasonably Achievable) principle. While lead aprons were always used by 379 (86.3%), thyroid shields were never used by 302 (68.8%) respondents. Knowledge about the ALARA principle was significantly associated with radiation safety practices. A significantly greater proportion of participants who were aware about the ALARA principle always used lead aprons (OR 1.15; 95% CI 1.0 to 1.2, p = 0.001) and thyroid shields (OR 2.00; 95% CI 1.0 to 3.7, p = 0.029) and had their dosimeters checked within the last 1 year (OR 1.69; 95% CI 1.0 to 2.8, p = 0.039) when compared to those who were not aware of the ALARA principle. Almost 99% respondents expressed interest in participating in a radiation safety training program. Conclusion A majority of the respondents were keen to obtain training in radiation safety. We believe that professional organizations and hospitals could initiate training programs for the orthopaedic community in India to improve their radiation safety knowledge and practices.

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

“…This study is one of largest reported surveys undertaken to assess radiation safety knowledge and principles for orthopaedic surgeons. The findings are supported by other studies in the literature, [5][6][7][8][9][10][11][12][13][14][15][16][17] the majority of which were smaller local or regional surveys with less than 90 orthopaedic surgeon responses. [5][6][7][8][9][10][11] Overall, they showed limited radiation safety knowledge, lack of formalised training and poor usage of radiation protective equipment.…”

“…Bowman et al 16 analysed 517 responses from US orthopaedic residents and reported substantial knowledge gaps in occupational safety and limited use of personal protective equipment with lack of availability of such equipment leading to decreased compliance. Ranade et al 17 reported the findings of their national survey of Indian orthopaedic trainees and consultants. Their results from 439 respondents showed limited radiation safety knowledge with only 16.2% being aware of the ALARA principle.…”

“…These findings are supported by other studies showing poor uptake of protective equipment by orthopaedic surgeons. [5][6][7][8][9][10][12][13][14][15][16][17] The importance of such equipment in minimising ionising radiation exposure is key due to well-documented carcinogenic risks of cumulative exposure. Surgeon's hands, eyes and thyroid are especially at risk due to their potential close proximity to the X-ray beam and increased radiosensitivity.…”

Intraoperative Fluoroscopy Radiation Using OEC 9900 Elite C-arm: Risk and Method for Decreasing Exposure

“…Despite some efforts, there has been a failure to recognize the increased occupational radiation exposure inherent with the increase in the frequency of fluoroscopically guided procedures (Chow et al 2013; Falavigna et al 2018; Harris et al 2019; Frane et al 2020; Ranade et al 2020). Furthermore, ignorance about safe radiation practice in the operating room includes using higher radiation C-arm default settings, absent or partial shielding (apron without thyroid shield, thyroid/waist without chest shield), and positioning in areas of maximum radiation scatter.…”