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Occupational Exposure from Common Fluoroscopic Projections Used in Orthopaedic Surgery

Investigation performed at University Hospital of Iraklion, Iraklion, Crete, Greece

Nicholas Theocharopoulos, MSc
Kostas Perisinakis, PhD
John Damilakis, PhD
Nicholas Gourtsoyiannis, MD
Department of Medical Physics (N.T., K.P., and J.D.) and Department of Radiology (N.G.), Faculty of Medicine, University of Crete, P.O. Box 1393, Iraklion 71500, Crete, Greece. E-mail address for J. Damilakis: damilaki{at}med.uoc.gr

George Papadokostakis, MD
Alexander Hadjipavlou, MD
Department of Orthopedics and Traumatology, University Hospital of Iraklion, P.O. Box 1393, Iraklion 71500, Crete, Greece

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Personnel assisting in or performing fluoroscopically guided procedures may be exposed to high doses of radiation. Accurate occupational dosimetric data for the orthopaedic theater staff are of paramount importance for practicing radiation safety.

Methods: Fluoroscopic screening was performed on an anthropomorphic phantom with use of four projections common in image-guided orthopaedic surgery. The simulated projections were categorized, according to the imaged anatomic area and the beam orientation, as (1) hip joint posterior-anterior, (2) hip joint lateral cross-table 45°, (3) lumbar spine anterior-posterior, and (4) lumbar spine lateral 90°. The scattered air kerma rate was measured on a grid surrounding the operating table. For each grid point, the effective dose, eye lens dose, and face skin dose values, normalized over the tube dose area product, were derived. For the effective dose calculations, three radiation protection conditions were considered: (1) with the exposed personnel using no protection measures, (2) with the exposed personnel wearing a 0.5-mm lead-equivalent protective apron, and (3) with the exposed personnel wearing both an apron and a thyroid collar. Maximum permissible workloads for typical hip, spine, and kyphoplasty procedures were derived on the basis of compliance with effective dose, eye lens dose, and skin dose limits.

Results: We found that the effective dose, eye lens dose, and face skin dose to an orthopaedic surgeon wearing a 0.5-mm lead-equivalent apron will not exceed the corresponding limits if the dose area product of the fluoroscopically guided procedure is <0.38 Gy m ² . When protective eye goggles are also worn, the maximum permissible dose area product increases to 0.70 Gy m ² , while the additional use of a thyroid shield allows a workload of 1.20 Gy m ² . The effective dose to the orthopaedic surgeon working tableside during a typical hip, spine, kyphoplasty procedure was 5.1, 21, and 250 µSv, respectively, when a 0.5-mm lead-equivalent apron alone was used. The additional use of a thyroid shield reduced the effective dose to 2.4, 8.4, and 96 µSv per typical hip, spine, and kyphoplasty procedure, respectively.

Conclusions: The levels of occupational exposure vary considerably with the type of fluoroscopically assisted procedure, staff positioning, and the radiation protection measures used. The data presented in the current study will allow for accurate estimation of the occupational dose to orthopaedic theater personnel.

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