Occupational radiation exposure from C arm fluoroscopy during common orthopaedic surgical procedures and its prevention

Abstract

Background: Image intensifiers have become popular due to the concept of minimally invasive surgeries leading to decreasing invasiveness, decreased operative time, and less morbidity. The drawback, however, is an increased risk of radiation exposure to surgeon, patient and theatre staff. These exposures have been of concern due to their potential ability to produce biological effects. The present study was embarked upon to analyse the amount of radiation received by orthopedic surgeons in India using standard precautionary measures and also to bring awareness about the use of image intensifier safety in everyday practice.

Materials and methods: Twelve right-handed male orthopedic surgeons (4 senior consultants, 5 junior consultants and 3 residents) were included in a three month prospective study for radiation exposure measurement with adequate protection measures in all procedures requiring C Arm fluoroscopy. Each surgeon was provided with 5 Thermo Luminescent Dosimeter (TLD) badges which were tagged at the level of neck, chest, gonads and both wrists. Operative time and exposure time of each procedure was recorded. Exposure dose of each badge at the end of the study was obtained and the results were analysed.

Results: Mean radiation exposure to all the parts were well within permissible limits. There was a significantly positive correlation between the exposure time and the exposure dose for the left wrist (r=0.735, p<0.01) and right wrist (r=0.58, p<0.05). The dominant hand had the maximum exposure overall.

Conclusion: Orthopaedic surgeons are not classified radiation workers. The mean exposure doses to all parts of the body were well within permissible limits. Nothing conclusive, however, can be said about the stochastic effects (chance effects like cancers). Any amount of radiation taken is bound to pose an additional occupational hazard. It is thus desirable that radiation safety precautions should be taken and exposures regularly monitored with at least one dosimeter for monitoring the whole-body dose.

Keywords: Image intensifiers; Radiation exposure in orthopaedics; Radiation hazards.

[Table/Fig-1]:

TLD Badges used were obtained from Bhaba Atomic Research Centre

[Table/Fig-2]:

Positioning of the TLD Badges

[Table/Fig-6]:

Zone of Primary Beam radiation: adapted from Gachiano et al., [16] who had shown that average amount of radiation received at 18 inches from primary beam was only 0.1% of that measured directly over femoral head

[Table/Fig-7]:

Zone of Scatter radiation is at the back of the X-ray tube: Alonso et al., [17] concluded that the scatter radiation outside 2 meter zone of a C Arm unit is less than 1 mSv