Radiation exposure to the hands of orthopaedic surgeons during procedures under fluoroscopic X-ray control

TLDR

The hands of orthopaedic surgeons are most likely to be directly exposed to ionizing radiation during fluoroscopic screening, yet little information exists on exposure levels during normal work patterns. The study aimed to directly measure hand radiation exposure during fluoroscopic screening in consecutive cases to determine whether surgeons should be classified as radiation‑exposed personnel and whether routine monitoring is warranted. Extremity monitoring used thermoluminescent dosimeters attached to the dominant index finger of nine surgeons across 44 procedures. Hand doses ranged from 48 to 2329 µSv, with 80 % of procedures below 100 µSv, and even the highest annual extrapolated dose was far below the 500 mSv extremity limit, indicating low exposure but recommending continued dose minimisation and periodic review.

Abstract

The hands of the surgeon are most likely to be directly exposed to ionizing radiation during fluoroscopic screening in the orthopaedic theatre. There is however little information available on the level of exposure to radiation during the normal working pattern of individual surgeons. The purpose of this study was to directly measure the radiation exposure to the hands during fluoroscopic screening in a series of consecutive cases over a month in order to establish whether these staff need to be designated classified persons, and if not, whether they need to be routinely monitored. Extremity monitoring was carried out using thermoluminescent dosimeters. The dosimeter was secured to the operating surgeon's dominant index finger. 44 procedures were carried out by nine different surgeons. The total radiation dose received per surgeon ranged from 48-2329 microSv. In 80% of procedures the dose of radiation to the surgeon's hand was less than 100 microSv. The extrapolated annual dose, even for the surgeon with the highest radiation exposure, was well below the annual dose limit for extremities of 500 mSv per year recommended by the International Commission on Radiological Protection, and embodied in the Ionizing Radiations Regulations 1985. Despite the relatively low doses of radiation received by surgeons in this study, occupational exposure to all personnel should be kept to the lowest practicable levels, and a review of procedures, including dose measurements, from time to time is advised.