Radiation exposure during fluoroscopy: Should we be protecting our thyroids?

Background: Recent reports on thyroid cancer among Australian orthopaedic s urgeons prompted the present study which sought to evaluate the effectivene ss of lead shielding in reducing radiation exposure (RE) to the thyroid reg ion during endo-urological procedures Methods: Radiation exposure to the thyroid region of the surgeon and scrubb ed nurse was monitored for 20 consecutive operations over a 6-week period b y thermoluminescent dosimeters (TLD). A TLD was placed over and underneath a thyroid shield of 0.5 mm lend equivalent thickness to monitor the effect of shielding. Results: Eight percutaneous nephrolithotomies, seven retrograde pyelograms and ureteric stentings and five ureteroscopies for calculous disease were m onitored. Total exposure time was 63.1 min. For the surgeon, the total cumu lative RE over and under the lead shield was 0.46 and 0.02 mSv, respectivel y, equating to a 23-times reduction in RE if shielding was used. This effec tively reduced RE to almost background levels, which was represented by the control TLD exposure (0.01 mSv). Conclusion: Although RE without thyroid shields did not exceed current stan dards set by radiation safety authorities, no threshold level has been set below which thyroid carcinogenesis is unlikely to occur. Because lead shiel ds are easy to wear and can effectively reduce RE to the thyroid region to near-background levels, they should be made easily available and used by al l surgeons to avoid the harmful effects of radiation on the thyroid.