The Great Hidden Risk.

Authors

  • Faaiz Ali Shah Associate Professor Orthopaedics Lady Reading Hospital Peshawar

Abstract

Fluoroscopy or C-arm imaging is frequently used in Orthopaedic surgery and  Orthopaedic surgeons are exposed to excessive ionizing radiation and they can be considered as high risk health care workers for occupational radiation exposure.1 This radiation exposure is an additional occupational hazard besides other risks of surgery because Orthopaedic surgeons are not classified radiation workers.2 Unfortunately majority of Orthopaedic surgeons lack the awareness and are less sensitive to radiation hazards because the effects of excessive radiation are manifested overs months or years and are not immediately manifested or observed.3 The C-arm fluoroscopy emits x-ray radiation which produces free radicals due to ionizing effects  which lead to direct DNA damage, cell death and biological damage.4

References

Gausden EB, Christ AB, Zeldin R, Lane JM, McCarthy MM. Tracking cumulative radiation exposure in orthopaedic surgeons and residents: what dose are we getting? J Bone Joint Surg Am. 2017;99(15):1324-13329.

Mahajan A, Samuel S, Saran AK, Mahajan MK, Mam MK. Occupational radiation exposure from C arm fluoroscopy during common orthopaedic surgical procedures and its prevention. J Clin Diagn Res. 2015;9(3):RC01-4. doi: 10.7860/JCDR/2015/10520.5672.

Abosala AA. Report on occupational ionizing radiation exposure by an orthopedic surgeon in a national health-care setting - clinical case perspective. J Orthop Case Reports. 2018;8(3):81-84.

Rehani MM, Ciraj-Bjelac O, Vano E, Miller DL, Walsh S, Giordano BD, et al. ICRP Publication 117. Radiological protection in fluoroscopically guided procedures performed outside the imaging department. Ann ICRP. 2010;40(6):1-102.

Gowda SR, Mitchell CJ, Abouel-Enin S, Lewis C. Radiation risk amongst orthopaedic surgeons–do we know the risk? J Perioper Pract. 2019;29:115–121.

Hamada N, Fujimichi Y. Classification of radiation effects for dose limitation purposes: history, current situation and future prospects. J Radiat Res. 2014 ;55(4):629-640.

Lopez M, Martin M. Medical management of the acute radiation syndrome. Rep Pract Oncol Radiother. 2011 Jul 13;16(4):138-146.

Singer G. Occupational radiation exposure to the surgeon. J Am Acad Orthop Surg. 2005;13:69–76.

Tsalafoutas IA, Tsapaki V, Kaliakmanis A, Pneumaticos S, Tsoronis F, Koulentianos ED, et al. Estimation of radiation doses to patients and surgeons from various fluoroscopically guided orthopaedic surgeries. Radiat Prot Dosimetry. 2008;128(1):112-9.

Alonso JA, Shaw DL, Maxwell A, McGill GP, Hart GC. Scattered radiation during fixation of hip fractures, Is distance alone enough protection? J Bone Joint Surg Br 2001; 83(6):815–818.

Ryu RC, Behrens PH, Malik AT, Lester JD, Ahmad CS. Are we putting ourselves in danger? Occupational hazards and job safety for Orthopaedic surgeons. J Orthop. 2021;24:96-101.

The 2007 recommendations of the international commission on radiological protection: ICRP publication 103. Ann ICRP. 2007;37:1–332.

Mastrangelo G, Fedeli U, Fadda E, Giovanazzi A, Scoizzato L, Saia B. Increased cancer risk among surgeons in an orthopaedic hospital. Occup Med. 2005;55(6):498–500.

Rampersaud YR, Raja Rampersaud Y, Foley KT, Shen AC, Williams S, Solomito M. Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine. 2000;25(20):2637–2645.

Muller LP, Suffner J, Wenda K, Mohr W, Rommens PM. Radiation exposure to the hands and the thyroid of the surgeon during intramedullary nailing. Injury. 1998;29(6):461–468.

Valone LC, Chambers M, Lattanza L, James MA. Breast radiation exposure in female Orthopaedic surgeons. J Bone Joint Surg Am. 2016;98(21):1808-1813.

Chou LB, Lerner LB, Harris AH, Brandon AJ, Girod S, Butler LM. Cancer prevalence among a cross-sectional survey of female orthopedic, urology, and plastic surgeons in the United States. Womens Health Issues. 2015;25:476–481

Chou LB, Chandran S, Harris AHS, Tung J, Butler LM. Increased breast cancer prevalence among female orthopedic surgeons. J Womens Health. 2012;21:683–689.

Jung GH, Jang JH, Kim JD, Kim CK. Radiation exposure over the course of a year from an image intensifier in the orthopaedic operating room. J Korean Fract Soc. 2012;25(1):58–63.

Tuncer N, Kuyucu E, Sayar S, Polat G, Erdil I, Tuncay I. Orthopedic surgeons’knowledge regarding risk of radiation exposition: a survey analysis. SICOT-J.2017;3:29.

Theocharopoulos N, Perisinakis K, Damilakis J, Papadokostakis G, Hadjipavlou A, Gourtsoyiannis N. Occupational exposure from common fluoroscopic projections used in Orthopaedic surgery. J Bone Joint Surg Am. 2003;85:1698-1703.

Giachino AA, Cheng M. Irradiation of the surgeon during pinning of femoral fractures. J Bone Joint Surg Br.1980;62-B(2):227-729.

Jain JK, Sen RK, Bansal SC, Nagi ON. Image intensifier and the orthopedic surgeon. Ind J Orthop. 2001;35(2):13-19.

Sanders R, Koval KJ, DiPasquale T, Schmelling G, Stenzler S, Ross E. Exposure of the orthopaedic surgeon to radiation. J Bone Joint Surg Am. 1993;75(3):326-30

Jones DG, Stoddart J. Radiation use in the Orthopaedic theatre: a prospective audit. Aust N Z J Surg. 1998;68(11):782-84.

Lester JD, Hsu S, Ahmad CS. Occupational Hazards Facing Orthopedic Surgeons. Am J Orthop. 2012;41(3):132-39

Badman BL, Rill L, Butkovich B, Arreola M, Griend RAV. Radiation Exposure with Use of the Mini-C-Arm For Routine Orthopaedic Imaging Procedures. J Bone Joint Surg Am. 2005;87(1):13-17.

Lacio EP, Ribeiro AA, Gavassi BM, Di Stasi GG, Galbiatti JA, Junior AD, et al. Exposure of the surgical team to ionizing radiation during orthopedic surgical procedures. Rev Bras Ortop. 2014;49:227–232.

Massey PA, Myers ME, Guedry RD, Lowery MT, Perry KJ, Barton RS. Improved Radiation Exposure Monitoring of Orthopaedic Residents After Institution of a Personalized Lead Protocol. JB JS Open Access. 2022;7(1):e21.00115. doi: 10.2106/JBJS.OA.21.00115.

Stirton JB, Savage AD, Pally EM, Kreder HJ, Mooney M. A standard universal C-arm language: Assessing its need and its likelihood of acceptance. J Orthop. 2018;16(1):61-63. doi: 10.1016/j.jor.2018.12.003.

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Published

2022-12-16

How to Cite

Faaiz Ali Shah. (2022). The Great Hidden Risk. Journal of Pakistan Orthopaedic Association, 34(04), 131–133. Retrieved from https://jpoa.org.pk/index.php/upload/article/view/690