RADIATION EXPOSURE TO THE ORTHOPEDIC SURGICAL-TEAM DURING FLUOROSCOPY- HOW FAR AWAY IS FAR ENOUGH

Objectives: To correlate the amount of radiation exposure to members o f the orthopaedic surgical team based on their relative positions duri ng a simulated fluoroscopically assisted orthopaedic procedure. Design : Experimental study using commercially available fluoroscopic units a nd dosimetry badges designed to measure ''eye'' (ocular lens), ''shall ow'' (hands/skin), and ''deep'' (whole-body) radiation exposure. Setti ng: Standard hospital operating room at a level one trauma center. Par ticipants: Dosimetry badge clusters at specified distances from a fluo roscopic x-ray beam. Represented positions were direct beam contact, s urgeon (12 in/30.5 cm), first assistant (24 in/70 cm), scrub nurse (36 in/91.4 cm), and anesthesiologist (60 in/152.4 cm). Intervention: Dos imetry badges were systematically exposed by a protocol intended to ma ximize radiation scatter. A maximum time for continuous fluoroscope us e was set at ten minutes. Main Outcome Measurements: Radiation exposur e readings from dosimetry badges processed by a commercially available dosimetry service. Results: Maximum readings are reported. Direct bea m contact resulted in approximately 4000 mrem/minute (40 mSv/min) of r adiation exposure. Deep exposure for the surgeon and first assistant w as 20 mrem/min (0.2 mSv/min) and 6 mrem/min (0.06 mSv/min), respective ly. Superficial exposure was 29 mrem/min (0.29 mSv/min) for the surgeo n and 10 mrem/min (0.1 mSv/min) for the first assistant. Eye exposure was 10 mrem/min (0.1 mSv/min) for the surgeon and 6 mrem/min (0.06 mSv /min) for the first assistant. At the scrub nurse position, no deep or eye exposure was detected. One positive badge for shallow exposure wa s noted at the scrub nurse position, reflecting a 2 mrem/min (0.02 mSv /min) exposure rate. After ten minutes of continuous exposure, badges assigned to the anesthesiologist position never registered any positiv e readings. Conclusions: These results indicate that unprotected indiv iduals working twenty-four inches (70 cm) or less from a fluoroscopic beam receive significant amounts of radiation, whereas those working t hirty-six inches (91.4 cm) or greater from the beam receive an extreme ly low amount of radiation.