Radiation exposure using laser aiming guide in orthopaedic procedures

Background: Ionizing radiation from intraoperative fluoroscopy presents a serious occupational health and safety concern to orthopaedic surgeons. The long-term effects of ionizing radiation are well known; they include damage to the eyes, increased risk of haematological malignancy and carcinomas throughout the body.(1-3) We studied the effect of using an attachable laser aiming guide on radiation exposure during intraoperative fluoroscopy. Methods: A prospective, randomized controlled trial was performed at a single institution. Eight hundred and eighty consecutive orthopaedic procedures involving fluoroscopy were randomized into two groups. One group had fluoroscopy without an aiming guide, the other group had fluoroscopy with the aiming guide. Total exposure time, number of exposures and the body region examined were recorded. Results: For most regions studied, no significant difference in exposure time or number of exposures was found. For hip fractures, use of the laser aiming device was associated with an increase in the number of exposures (P=0.035), but there was no significant difference in average exposure time (P=0.31). Use of the aiming device was associated with an increased number of exposures (P=0.0025) and an increased exposure time (P=0.0016) for examination of the wrist, but this may represent selection bias. Conclusion: Use of a laser aiming device during intraoperative fluoroscopy was not associated with decreased exposure to radiation.