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Highest Radiation? Trauma and Deformity Surgeons!

Elizabeth Hofheinz, M.P.H., M.Ed. • Fri, August 18th, 2017

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Trauma and deformity surgeons should be especially careful to gear up against radiation exposure, says new work from Hospital for Special Surgery (HSS) in New York. The research, “Tracking Cumulative Radiation Exposure in Orthopaedic Surgeons and Residents: What Dose Are We Getting?” appears in the August 2, 2017 edition of The Journal of Bone and Joint Surgery.

The authors wrote, “Monthly radiation exposure was measured over a 12-month period for 24 orthopaedic residents and 16 orthopaedic attending surgeons. The participants wore a Landauer Luxel dosimeter on the breast pocket of their lead apron. The dosimeters were exchanged every rotation (5 to 7 weeks) for the resident participants and every month for the attending surgeon participants. Radiation exposure was compared by orthopaedic subspecialty, level of training, and type of fluoroscopy used (regular C-arm compared with mini C-arm).”

“Orthopaedic residents participating in this study received monthly mean radiation exposures of 0.2 to 79 mrem/month, lower than the dose limits of 5,000 mrem/year recommended by the United States Nuclear Regulatory Commission (U.S. NRC).

“Senior residents rotating on trauma were exposed to the highest monthly radiation (79 mrem/month [range, 15 to 243 mrem/month]) compared with all other specialty rotations. Similarly, attending orthopaedic surgeons who specialize in trauma or deformity surgery received the highest radiation exposure of their peers, and the mean exposure was 53 mrem/month (range, 0 to 355 mrem/month.).”

Moira McCarthy, M.D. is an orthopedic surgeon at HSS, and a co-author on the study. She commented to OTW, “I became interested in this topic as a resident. I was using radiation for various uses almost every day. Residents use radiation in the emergency room to reduce fractures several times per night and in the OR [operating room] on a daily basis to ensure appropriate fixation and reduction of fractures.”

“I felt like I was getting radiated a lot and was interested in the overall radiation dose to residents and attendings in different orthopedic specialties. Also, although rare, I was aware of several cases of orthopedic surgeons, females in particular, who developed cancers. As a secondary reason, I wondered whether or not high radiation exposure could be a potential cause.”

“Everyone gets some radiation and some specialties and levels of expertise get more than others. Thinking about this while training definitely had an influence in what field of medicine/surgery/orthopedics I chose to pursue.”
“Everyone should be aware of the risks associated with their chosen job and specialty. Those specialties with higher exposure should take extra precautions to protect themselves with radiation shields for the body, thyroid, and eyes.”

“Radiation is a part of this job. Everyone should protect him or herself appropriately for even the smallest amount of radiation exposure because it is cumulative. Protection from every little bit is potentially helpful in the long run.”

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One Response to “Highest Radiation? Trauma and Deformity Surgeons!”

  1. Frederick Buechel, Jr. MD says:

    Thank you for this important article.
    We physicians are not well educated about the radiation we are exposed to during our training and long careers.
    We are asked by our Operating room leaders to wear radiation badges but it is often not mandatory and commonly forgotten by many.

    This article is helpful by informing us that the radiation levels behind the lead we wear is controlled to “safe levels”.

    My comment that we need to all think about is: What is the radiation dose to these providers in the areas not covered by the lead aprons?
    Specifically, what is the skull, brain, Face skin, and eye dose they are receiving? If they are not wearing lead gloves, what are the hand and arm skin doses of radiation they are receiving?

    I relearned during my study for the Orthopaedic Board Recertification Exam that eye cataract formation from radiation exposure is cumulative so I began always wearing lead eye glasses for any radiation cases. This is not standard of practice in our industry, but it seems as though it should be, from the data available on this.

    I hope the authors continue in their great research of radiation exposure in the healthcare provider workplace, and include more regions of the body that are not covered by lead so we can learn about risk exposure levels in these other areas.

    It would also be of help for all users of radiation to have standardized the apron specifications for greatest safety, meaning the thickness, material, coverage requirements, testing of aprons for effectiveness and potential damage.

    Thank you for your time.

    Frederick Buechel, Jr. MD
    Orthopaedic Surgeon
    Robotic Joint Center
    New York * Taiwan
    http://www.RoboticJointCenter.com

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