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Radiation protection of medical staff in orthopedic surgery

» How much radiation is safe for me?

There are radiation dose limits for staff recommended by the International Commission on Radiological Protection (ICRP) that most countries tend to adopt. Currently the level is 20 mSv/year (actually 100 mSv in 5 years - not to exceed 50 mSv in any one year). This dose limit is based on the calculation of radiation risk over a full working life from the age of 18 years to 65 years (47 years) at the rate of 20 mSv per year, amounting to 20x47= 0.94 Sv and resulting in an excess cancer risk of 1 in 1000. Most orthopaedic surgeons using radiation protection devices and tools will have a radiation dose below typically 2 mSv/year.

Table 1: Approximate dose to the surgeon per procedure (µSv) with 0.5 mm lead apron worn*

ProcedureDose
to the
Surgeon per
procedure
(µSv)
Screening
Time
Hip 5 25 sec/patient
Spine 21 2 min/patient
Kyphoplasty 250 10 min/patient

* Occupational exposure from common fluoroscopic projections used in orthopedic Surgery.

» Is the dose to orthopaedic surgeons much higher than other interventionalists?

No.

The radiation dose to orthopaedic and trauma surgeons in most routine procedures is much smaller than those performing cardiac interventions.

» Is there a risk of cataract after several years of work in an orthopaedic operating room?

Very unlikely. Proper use of radiation protection tools and techniques can prevent deterministic effects such as cataract and can avoid any significant increase in probability of cancer risk for many years to cover the full professional life. To date, there have been no reports of radiation induced cataract among orthopaedic surgeons, however such reports do exist for interventional radiologists and cardiologists.

» Can I work my full professional life with radiation in the operating room and have no radiation effects?

Yes it is possible. Under optimized conditions when

  • the equipment is periodically tested and it is operating properly;
  • personal protective devices (lead apron of suitable lead equivalence of 0.25 to 0.5 mm and wrap around type, protective eye wear or protective shields are used for the head/face and leg regions);
  • use of personnel monitoring devices is implemented to estimate radiation exposure; 
  • proper techniques are employed as in Question 3 above. 

It is possible to achieve a smaller risk of radiation effects for a full professional life using the ALARA (as low as reasonably achievable) principle. There are situations where protection of patients poses a great challenge, but this is not so much the case for staff, where protection can be reasonably achieved. 

» What are the typical radiation doses associated with orthopaedic procedures?

Typical values in terms of effective doses are presented in Table 2 below.

Table 2: Mean effective doses from Orthopaedic procedures

ProcedureMean
effective
dose
(mSv)Equivalent
number of
PA chest
radiographs
(each 0.02 mSv)
Other
extremities [ME]
0.001 0.05
Knee [ME] 0.005 0.25
Shoulder [ME] 0.01 0.5
Sternum [HA] 0.01 0.5
TM joint [HA] 0.012 0.6
Skull [ME] 0.1 5
Arthrography [HA] 0.17 8.5
Cervical
Spine [ME]
0.2 10
Lumbosacral
joint [HA]
0.34 17
Upper extremity
angiography [BO]
0.56 28
Pelvis [ME] 0.6 30
Hip [ME] 0.7 35
Thoracic
Spine [ME]
1 50
Lumbar
Spine [ME]
1.5 75
Myelography [HA] 2.46 123
Lower
extremity
angiography [BO]
3.5 175
Thoracic
aortography [HA]
4.1 205
Peripheral
arteriography [HA]
7.1 355

References:

  • BOR, D., T. SANCAK, T. OLGAR et al. Comparison of effective doses obtained from dose-area product and air kerma measurements in interventional radiology. Br. J. Radiol. 77916 (2004) 315-322. 
  • CIRAJ-BJELAC, O., REHANI, M.M., SIM, K.H., LIEW, H.B., VANO, E., KLEIMAN, N.J., Risk for radiation induced cataract for staff in interventional cardiology: Is there reason for concern? Catheter. Cardiovasc. Interv. (Jun. 2010). 
  • CRAWLEY, M.T., ROGERS, A.T., Dose-area product measurements in a range of common orthopaedic procedures and their possible use in establishing local diagnostic levels. Br. J. Radiol. 73 (2000) 740-744. 
  • HART, A., WALL, B.F., Radiation exposure of the UK population from medical and dental x-ray examinations. NRPB-W4 (2002) 
  • METTLER FA, HUDA W, YOSHIZUMI TT, AND MAHESH M. Effective Doses in Radiology and Diagnostic Nuclear Medicine: A Catalog. Radiology 248 1 (2008) 254-263. 
  • THEOCHAROPOULOS, N., PERISINAKIS, K., DAMILAKIS, J., PAPADOKOSTAKIS, G., HADJIPAVLOU, A., GOURTSOYIANNIS, N., Occupational Exposure from Common Fluoroscopic Projections Used in Orthopaedic Surgery. The Journal of Bone and Joint Surgery, 85 (2003) 1698-1703. 
  • VANO, E., GONZALEZ, L., BENEYTEZ, F., MORENO, F., Lens injuries induced by occupational exposure in non-optimised interventional radiology laboratories, Br. J. Radiol. 71 (1998) 728-733. 
  • VANO, E., KLEIMAN, N.J., DURAN, A., REHANI, M.M., ECHEVERRI, D., CABRERA, M., Radiation cataract risk in interventional cardiology personnel. Radiat Res. 174 4 (2010) 490-495.