Simple Way to Reduce Radiation Exposure in the Orthopaedic Operating Theater: An 18-month Prospective Study

Background: Orthopaedic trauma surgeons are increasingly exposed to ionizing radiation owing to a rise in the number of fluoroscopically-guided procedures. This study measured radiation exposure to the trauma surgeon and the operation room personnel as part of the study after applying our strategy in minimizing exposure risk and compared the results to the exposure in the surgical field. Materials and Methods: From July 2012 to December 2013, we prospectively measured radiation exposure using five Thermo-luminescent Dosimeters (TLDs) placed in the surgical field, on the first assistant, on the trauma surgeon below and upon the lead apron at the chest level, and at a constant distance-maintained point behind the image intensifier, being 146 cm from the X-ray tube. To keep radiation exposure to as low as possible, a simple strategy was followed, which consisted of a particular room set-up and instructions on how to use the image intensifier. Concerning the room arrangement, the fluoroscopic monitor was placed at least 1.5 m away from the operating table. As such, the surgeon and the assistants had to move toward the monitor and turn against the image intensifier to view and verify the fluoroscopic images. Results: The total radiation time in 185 procedures was 141 min, 56 sec. TLD exposure in the surgical field was 5.58 mSv (representing 100% exposure). TLD for the first assistant was 0.09 mSv (exposure ratio of 1.61%). The distance-maintained TLD exposure was 0.06 mSv (exposure ratio of 1.08%). TLD exposure over and under the lead apron of the trauma surgeon was 1.25 mSv and 0.06 mSv, respectively, corresponding to an exposure ratio of 22.4% and 1.08%, respectively. Conclusion: By following simple guidelines and the surgeon's awareness in reducing use-time, the orthopaedic trauma team could significantly reduce radiation exposure. From the analysis of distance-maintained TLD (146 cm), the radiation exposure could be kept to as low as possible by both maintaining a 1.5 m distance from the source and wearing a lead apron.