Improved Radiation Exposure Monitoring of Orthopaedic Residents After Institution of a Personalized Lead Protocol

Abstract

Radiation exposure of orthopaedic residents should be accurately monitored to monitor and mitigate risk. The purpose of this study was to determine whether a personalized lead protocol (PLP) with a radiation monitoring officer would improve radiation exposure monitoring of orthopaedic surgery residents.

Materials and methods: This was a retrospective case-control study of 15 orthopaedic surgery residents monitored for radiation exposure during a 2-year period (March 2017 until February 2019). During the first 12-month period (phase 1), residents were given monthly radiation dosimeter badges and instructed to attach them daily to the communal lead aprons hanging outside the operating rooms. During the second 12-month period (phase 2), a PLP (PLP group) was instituted in which residents were given lead aprons embroidered with their individual names. A radiation safety officer was appointed who placed the badges monthly on all lead aprons and collected them at the end of the month, whereas faculty ensured residents wore their personalized lead apron. Data collected included fluoroscopy use time and radiation dosimeter readings during all orthopaedic surgeries in the study period.

Results: There were 1,252 orthopaedic surgeries using fluoroscopy during phase 1 in the control group and 1,269 during phase 2 in the PLP group. The total monthly fluoroscopy exposure time for all cases averaged 190 minutes during phase 1 and 169 minutes during phase 2, with no significant difference between the groups (p < 0.45). During phase 1, 73.1% of the dosimeters reported radiation exposure, whereas during phase 2, 88.7% of the dosimeters reported radiation exposure (p < 0.001). During phase 1, the average monthly resident dosimeter exposure reading was 7.26 millirems (mrem) ± 37.07, vs. 19.00 mrem ± 51.16 during phase 2, which was significantly higher (p < 0.036).

Conclusions: Institution of a PLP increased the compliance and exposure readings of radiation dosimeter badges for orthopaedic surgery residents, whereas the actual monthly fluoroscopy time did not change. Teaching hospitals should consider implementing a PLP to more accurately monitor exposure.

Level of evidence: 3.

Fig. 1

(Fig. 1-A) Traditional lead provided by the hospital for techs, circulators, attendings, residents, anesthesiologists, and students. Thyroid shields were not attached. Only one size was available. Everyone in the operating room had access to this lead. This was the lead available for orthopaedic residents during phase 1 for the control group. Fig. 1-B: Personalized lead aprons hanging in a secure room with combination lock access. Various patterns have been chosen by each resident based on individual choices. Thyroid shields are attached. Lead aprons have been fitted to the size of the resident’s choice. Radiation dosimeter badges are monthly switched out on the front of the aprons.

Fig. 2

Average monthly radiation exposure (mrem) for deep dose equivalent, lens dose equivalent, and shallow dose equivalent before and after the implementation of the personalized lead protocol (PLP). During phase 1, the average monthly resident dosimeter exposure reading was 7.26 mrem ± 37.07 vs. 19.00 mrem ± 51.16 during phase 2, which was significantly higher (p = 0.036).

Fig. 3

Individual resident monthly dosimeter measurements (mrem) before and after personalized lead protocol (PLP).