Whole-body radiation exposure in Trauma and Orthopaedic surgery

Abstract

Aims The use of fluoroscopy in orthopaedic surgery creates risk of radiation exposure to surgeons. Appropriate personal protective equipment (PPE) can help mitigate this. The primary aim of this study was to assess if current radiation protection in orthopaedic trauma is safe. The secondary aims were to describe normative data of radiation exposure during common orthopaedic procedures, evaluate ways to improve any deficits in protection, and validate the use of electronic personal dosimeters (EPDs) in assessing radiation dose in orthopaedic surgery. Methods Radiation exposure to surgeons during common orthopaedic trauma operations was prospectively assessed using EPDs and thermoluminescent dosimeters (TLDs). Normative data for each operation type were calculated and compared to recommended guidelines. Results Current PPE appears to mitigate more than 90% of ionizing radiation in orthopaedic fluoroscopic procedures. There is a higher exposure to the inner thigh during seated procedures. EPDs provided results for individual procedures. Conclusion PPE currently used by surgeons in orthopaedic trauma theatre adequately reduces radiation exposure to below recommended levels. Normative data per trauma case show specific anatomical areas of higher exposure, which may benefit from enhanced radiation protection. EPDs can be used to assess real-time radiation exposure in orthopaedic surgery. There may be a role in future medical wearables for orthopaedic surgeons. Cite this article: Bone Jt Open 2022;3(11):907–912.

Protecting female healthworkers from ionising radiation at work

“…Simulated intraoperative positioning showed a large variance in radiation exposure, inadequate protection of the upper outer quadrant, and no significant reduction in dose when a standard protective gown was compared with a torso without protection 78. A separate study that placed dosimeters over a standard protective gown worn by orthopaedic surgeons identified that the area adjacent to the axilla received the highest radiation dose in the upper body 18…”

“…7 8 A separate study that placed dosimeters over a standard protective gown worn by orthopaedic surgeons identified that the area adjacent to the axilla received the highest radiation dose in the upper body. 18 The International Commission on Radiation Protection revised its guidelines in 2007 to double the relative detriment of ionising radiation for breast cancer, due to a historical underestimation of the impact of ionising radiation on breast tissue. 19 No occupational dose limits exist for breast tissue, in contrast to other radiation sensitive areas such as the eyes and thyroid.…”

Virtual reality training for intraoperative imaging in orthopaedic surgery: an overview of current progress and future direction

“…Trauma and orthopedic surgery commonly rely on intraoperative radiography or fluoroscopy. Orthopaedic surgeons and other members of the surgical team face the risk of exposure to ionizing radiation during intraoperative radiography or fluoroscopy (Mehlman and DiPasquale, 1997;Matityahu et al, 2017;Rashid et al, 2018;Hurley et al, 2022;Dorman et al, 2023). Patients and personnel assisting in, or performing fluoroscopically guided procedures may be exposed to high doses of radiation, with the highest dosage affecting the hands and wrist (Hafez et al, 2005;Singer, 2005).…”