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 of the 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 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 twenty-eight millirems. The highest average dose of radiation (100 millirems) was recorded during the procedures involving femoral nailing with both proximal and distal interlocking.