Exposure of the orthopaedic surgeon to radiation.

A prospective study of sixty-five orthopaedic procedures performed with fluoroscopic assistance was undertaken to determine the risk to the primary orthopaedic surgeon with regard to radiation. Radiation was monitored with the use of a universal film badge placed outside the collar of a lead apron, and a gas-sterilized thermoluminescent dosimeter ring worn on each hand. The rings were changed with every operation, but the same film badge was transferred from surgeon to surgeon. The hand dominance of the surgeon, the duration of the operative procedure, the type of operation, and the total time that fluoroscopy had been used were noted. The study was conducted during twenty-one intramedullary nailing procedures (thirteen involving distal locking), forty open reductions with internal fixation (plates and screws), and four external-fixation procedures. All of the badges and rings were submitted for a report regarding radiation exposure. No relationship was found between a ring with a positive reading for exposure to radiation and the duration of the operation. Similarly, there was no correlation between a positive reading and the surgeon’s hand dominance. The mean duration ofthe fluoroscopy was 2.3 minutes for the group for which the rings did not show a positive reading and 4.7 minutes for the group for which the rings did show a positive reading. This was a significant difference (p < 0.0001). There was no positive reading for exposure to radiation from any ring that had been worn during a procedure in which the fluoroscope had been used for less than 1.7 minutes. According to the readings from the universal film badges, the total cumulative exposure to radiation for the duration of the study was 0.0 millirems. The readings from the thermoluminescent dosimeter rings were *No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study. tThe Florida Orthopaedic Institute, 4175 East Fowler Avenue, Tampa, Florida 33617-2011. Please address requests for reprints to Dr. Sanders. 1The Hospital forJoint Diseases,Orthopaedic Institute,301 East 17th Street, New York, N.Y. 10003. §Department of Orthopaedics, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois 60153. ciDepartment of Radiology, Tampa General Hospital, One Davis Island, Tampa, Florida 33601. #Department of Population Science, Foxchase Cancer Center, 7701 Burholm Avenue,Foxchase,Pennsylvania 19111. positive for exposure to radiation for eight (12 per cent) of the sixty-five procedures; the average dose was 9.85 millirems for each procedure. Fluoroscopy was used for a longer duration during the intramedullary nailing procedures (mean duration, 3.6 minutes) than during the other types of operations (mean duration, 2.1 minutes). The readings for exposure to radiation were positive for 29 per cent (six) of the twenty-one intramedullary nailing procedures, compared with 5 per cent (two) of the other forty-four operations (p < 0.01). For the subset of twenty-one intramedullary nailing procedures, the average dose of radiation for each procedure, as recorded by the rings, was twentyeight millirems. The highest average dose of radiation (100 millirems) was recorded during the procedures involving femoral nailing with both proximal and distal interlocking. Procedures done with fluoroscopic assistance can result in less devitalization of soft tissue because the extent of the operative exposure is decreased. However, one potential hazard for the surgeon is increased exposure of the hands to radiation. A common procedure that can serve as an example is insertion of a distal screw during intramedullary nailing, but newer techniques such as percutaneous fixation of fractures with cannulated screws also raise concerns. This led us to evaluate the actual exposure of the hands of the primary orthopaedic surgeon to radiation during a series of operations for the treatment of fractures in which fluoroscopic guidance was employed. Materials and Methods During the three-month period of December 1990 to February 1991, a study was undertaken to evaluate exposure of the hands of the primary orthopaedic surgeon to radiation. Either an attending orthopaedic surgeon whose main interest was trauma, or a fellow on the Orthopaedic Trauma Service, was the primary surgeon for each operation. The primary surgeon was never an orthopaedic resident. The study was designed in this way so that we could more accurately approximate the operative times for experienced orthopaedic surgeons in a community setting. Standard fluoroscopic techniques were carefully followed in the study348. A lead apron was worn over the anterior aspect of the trunk. The surgeon always faced the machine when imaging was taking place, so that the