X-ray in trauma and orthopedic surgery. Physical and biological impact, reasonable use, and radiation protection in the operating room

Orthopedic and especially trauma surgeons' use of x-rays during operations vary extensively, especially in minimally invasive osteosynthesis procedures. Radiation hazards often are neglected. In this paper, a short overview of physical and biological effects of radiation are given. In addition, practical information about how to lower radiation exposure in the daily work in the operating room (OR) is given. The operating team is exposed mainly to scattered radiation. The radiation exposure is 10 times higher on the tube side than on the amplifier side. The distance between tube and surgeon must be as great as possible. The tube should be positioned under the OR table, and the distance between tube and patient should be as short as possible. The positioning of the C-arm device without radiation is important. The use of patient landmarks is used to position the C-arm over the region of interest, but the preoperative training of surgeons and team with virtual learning tools, e.g., virtX, is very effective in reducing radiation hazards.