Radiation use in the orthopaedic theatre: A prospective audit

Background: There is concern about the exposure of orthopaedic surgeons to radiation. The aim of this study was to monitor radiation use in theatre to improve practice and to attempt to quantify the radiation dose the orthopaedic surgeon may have received. Methods: A 6-month prospective audit of all procedures performed in the orthopaedic theatre that used fluoroscopy or radiographs was undertaken An anthropomorphic phantom was used to measure scatter and direct-skin doses. Screening times were recorded in a subsequent 6-month post at a tertiary trauma centre. Results: Fluoroscopy or radiographs were used in 378 procedures. Fluoroscopy was used in 260 procedures with a screening time of 124 min at an average of 0.48 min pet procedure. Lead aprons were worn in 99% of cases and thyroid guards in 32%. All dosimeter badges were negative. The surgeon's hand was caught in the fluoroscopy beam in 15% of procedures. The phantom recordings ranged from 13 to 210 microGy for skin dose and 0.17-0.87 microGy for scatter dose. The calculated hand exposure was less than 5% of recommended levels. In the trauma post 210 min of screening was used potentially increasing the hand exposure to one-third of recommended limits. If a printer was used to record the image, 58% of intra-operative radiographs would have been avoided. Conclusions: Hand exposure to radiation is the limiting factor in orthopaedics. The extremity limit will only be exceeded if the hands are regularly caught in the beam. Dose-reduction gloves should be considered for high-risk procedures. A printer can reduce the need for intraoperative plain radiographs.