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Published in: European Journal of Orthopaedic Surgery & Traumatology 5/2021

01-07-2021 | Ionizing Radiation | General Review

The use of ionising radiation in orthopaedic surgery: principles, regulations and managing risk to surgeons and patients

Authors: Mohsen Raza, James Houston, Ryan Geleit, Rachel Williams, Alex Trompeter

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 5/2021

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Abstract

The use of ionising radiation for plain film radiography and computerised tomography is fundamental in both diagnostics and treatment for orthopaedics. However, radiation is not without risk as high exposure can increase the risk of cancer. Little time is spent educating doctors about the relative risks of radiation, both to patients and themselves. In addition, there are common misunderstandings about the best ways to mitigate such risk. We aim to provide an overview of the fundamental principles of the use of ionising radiation and its risks within the context of orthopaedic surgery. While providing a narrative review of the current literature, we discuss the basic physics, standards of good practice and relevant UK and European regulations. We discuss the risks to patients and surgeons and suggest ways that these can be mitigated in the operating theatre. A thorough understanding of the risks, and appropriate procedural rules, with respect to the use of ionising radiation is essential for those in orthopaedic practice.
Literature
6.
go back to reference Munro, Leonie, Ostensen, Harald, Ingolfsdottir, Gudrun & World Health Organization (2004) Diagnostic imaging and laboratory technology team Basics of radiation protection for everyday use: how to achieve ALARA : working tips and guidelines / Editors: Harald Ostensen, Gudrun Ingolfsdottir ; author: Leonie Munro. World Health Organization. https://apps.who.int/iris/handle/10665/42973. Accessed 1 Nov 2020 Munro, Leonie, Ostensen, Harald, Ingolfsdottir, Gudrun & World Health Organization (2004) Diagnostic imaging and laboratory technology team Basics of radiation protection for everyday use: how to achieve ALARA : working tips and guidelines / Editors: Harald Ostensen, Gudrun Ingolfsdottir ; author: Leonie Munro. World Health Organization. https://​apps.​who.​int/​iris/​handle/​10665/​42973. Accessed 1 Nov 2020
11.
go back to reference ICRP (2007). The 2007 recommendations of the international commission on radiological protection. ICRP Publication 103. Ann ICRP. 37 (2–4) ICRP (2007). The 2007 recommendations of the international commission on radiological protection. ICRP Publication 103. Ann ICRP. 37 (2–4)
25.
go back to reference ICRP (2013). Radiological protection in paediatric diagnostic and interventional radiology. ICRP Publication 121. Ann. ICRP 42(2) ICRP (2013). Radiological protection in paediatric diagnostic and interventional radiology. ICRP Publication 121. Ann. ICRP 42(2)
26.
go back to reference Brenner DJ, Elliston CD, Hall EJ, Berdon WE (2001) Estimates of the cancer risks from pediatric CT radiation are not merely theoretical: comment on point/counterpoint: in x-ray computed tomography, technique factors should be selected appropriate to patient size against the proposition. Med Phys 28(11):2387–2388CrossRefPubMed Brenner DJ, Elliston CD, Hall EJ, Berdon WE (2001) Estimates of the cancer risks from pediatric CT radiation are not merely theoretical: comment on point/counterpoint: in x-ray computed tomography, technique factors should be selected appropriate to patient size against the proposition. Med Phys 28(11):2387–2388CrossRefPubMed
37.
go back to reference Smith GL, Wakeman R, Briggs TW (1996) Radiation exposure of orthopaedic trainees: quantifying the risk. J R Coll Surg Edinb 41(2):132–134PubMed Smith GL, Wakeman R, Briggs TW (1996) Radiation exposure of orthopaedic trainees: quantifying the risk. J R Coll Surg Edinb 41(2):132–134PubMed
38.
go back to reference Smith DL, Heldt JP, Richards GD, Agarwal G, Brisbane WG, Chen CJ, Chamberlin JD, Baldwin DD (2013) Radiation exposure during continuous and pulsed fluoroscopy. J Endourol 27(3):384–388CrossRefPubMed Smith DL, Heldt JP, Richards GD, Agarwal G, Brisbane WG, Chen CJ, Chamberlin JD, Baldwin DD (2013) Radiation exposure during continuous and pulsed fluoroscopy. J Endourol 27(3):384–388CrossRefPubMed
39.
go back to reference Tsalafoutas IA, Tsapaki V, Kaliakmanis A, Pneumaticos S, Tsoronis F, Koulentianos ED, Papachristou G (2007) Estimation of radiation doses to patients and surgeons from various fluoroscopically guided orthopaedic surgeries. Radiat Prot Dosim 128(1):112–119CrossRef Tsalafoutas IA, Tsapaki V, Kaliakmanis A, Pneumaticos S, Tsoronis F, Koulentianos ED, Papachristou G (2007) Estimation of radiation doses to patients and surgeons from various fluoroscopically guided orthopaedic surgeries. Radiat Prot Dosim 128(1):112–119CrossRef
40.
go back to reference Arnstein PM, Richards AM, Putney R (1994) The risk from radiation exposure during operative X-ray screening in hand surgery. J Hand Surg Br 19(3):393–396CrossRefPubMed Arnstein PM, Richards AM, Putney R (1994) The risk from radiation exposure during operative X-ray screening in hand surgery. J Hand Surg Br 19(3):393–396CrossRefPubMed
42.
go back to reference Muller LP, Suffner J, Wenda K, Mohr W, Rommens PM (1998) Radiation exposure to the hands and the thyroid of the surgeon during intramedullary nailing. Injury 29(6):461–468CrossRefPubMed Muller LP, Suffner J, Wenda K, Mohr W, Rommens PM (1998) Radiation exposure to the hands and the thyroid of the surgeon during intramedullary nailing. Injury 29(6):461–468CrossRefPubMed
43.
go back to reference Dewey P, Incoll I (1998) Evaluation of thyroid shields for reduction of radiation exposure to orthopaedic surgeons. Aust N Z J Surg 68(9):635–636CrossRefPubMed Dewey P, Incoll I (1998) Evaluation of thyroid shields for reduction of radiation exposure to orthopaedic surgeons. Aust N Z J Surg 68(9):635–636CrossRefPubMed
47.
49.
go back to reference Stewart FA, Akleyev AV, Hauer-Jensen M, Hendry JH, Kleiman NJ, Macvittie TJ, Aleman BM, Edgar AB, Mabuchi K, Muirhead CR, Shore RE, Wallace WH (2012) ICRP publication 118: ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs–threshold doses for tissue reactions in a radiation protection context. Ann ICRP 41(1–2):1–322. https://doi.org/10.1016/j.icrp.2012.02.001CrossRefPubMed Stewart FA, Akleyev AV, Hauer-Jensen M, Hendry JH, Kleiman NJ, Macvittie TJ, Aleman BM, Edgar AB, Mabuchi K, Muirhead CR, Shore RE, Wallace WH (2012) ICRP publication 118: ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs–threshold doses for tissue reactions in a radiation protection context. Ann ICRP 41(1–2):1–322. https://​doi.​org/​10.​1016/​j.​icrp.​2012.​02.​001CrossRefPubMed
52.
go back to reference Singer G, Herron B, Herron D (2011) Exposure from the large C-arm versus the mini C-arm using hand/wrist and elbow phantoms. The Journal of hand surgery 36(4):628–631CrossRefPubMed Singer G, Herron B, Herron D (2011) Exposure from the large C-arm versus the mini C-arm using hand/wrist and elbow phantoms. The Journal of hand surgery 36(4):628–631CrossRefPubMed
53.
go back to reference Mehlman CT, DiPasquale TG (1997) Radiation exposure to the orthopaedic surgical team during fluoroscopy: “how far away is far enough?” J Orthop Trauma 11(6):392–398CrossRefPubMed Mehlman CT, DiPasquale TG (1997) Radiation exposure to the orthopaedic surgical team during fluoroscopy: “how far away is far enough?” J Orthop Trauma 11(6):392–398CrossRefPubMed
54.
go back to reference Alonso JA, Shaw DL, Maxwell A, McGill GP, Hart GC (2001) Scattered radiation during fixation of hip fractures is distance alone enough protection? J Bone Joint Surg Br 83(6):815–818CrossRefPubMed Alonso JA, Shaw DL, Maxwell A, McGill GP, Hart GC (2001) Scattered radiation during fixation of hip fractures is distance alone enough protection? J Bone Joint Surg Br 83(6):815–818CrossRefPubMed
55.
go back to reference Yu E, Khan SN (2014) Does less invasive spine surgery result in increased radiation exposure? A systematic review. Clin Orthop Relat Res® 472(6):1738–1748CrossRef Yu E, Khan SN (2014) Does less invasive spine surgery result in increased radiation exposure? A systematic review. Clin Orthop Relat Res® 472(6):1738–1748CrossRef
56.
go back to reference Rampersaud YR, Foley KT, Shen AC, Williams S, Solomito M (2000) Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine 25(20):2637–2645CrossRefPubMed Rampersaud YR, Foley KT, Shen AC, Williams S, Solomito M (2000) Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine 25(20):2637–2645CrossRefPubMed
57.
go back to reference van der Merwe B (2012) Radiation dose to surgeons in theatre. S Afr J Surg 50(2):26–29PubMed van der Merwe B (2012) Radiation dose to surgeons in theatre. S Afr J Surg 50(2):26–29PubMed
61.
go back to reference Lee SY, Min E, Bae J, Chung CY, Lee KM, Kwon S-S, Park MS, Lee K (2013) Types and arrangement of thyroid shields to reduce exposure of surgeons to ionizing radiation during intraoperative use of C-arm fluoroscopy. Spine 38(24):2108–2112CrossRefPubMed Lee SY, Min E, Bae J, Chung CY, Lee KM, Kwon S-S, Park MS, Lee K (2013) Types and arrangement of thyroid shields to reduce exposure of surgeons to ionizing radiation during intraoperative use of C-arm fluoroscopy. Spine 38(24):2108–2112CrossRefPubMed
62.
go back to reference Struelens L, Schoonjans W, Schils F, De Smedt K, Vanhavere F (2013) Extremity and eye lens dosimetry for medical staff performing vertebroplasty and kyphoplasty procedures. J Radiol Prot 33(3):635CrossRefPubMed Struelens L, Schoonjans W, Schils F, De Smedt K, Vanhavere F (2013) Extremity and eye lens dosimetry for medical staff performing vertebroplasty and kyphoplasty procedures. J Radiol Prot 33(3):635CrossRefPubMed
63.
go back to reference Mechlenburg I, Daugaard H, Søballe K (2009) Radiation exposure to the orthopaedic surgeon during periacetabular osteotomy. Int Orthop 33(6):1747CrossRefPubMed Mechlenburg I, Daugaard H, Søballe K (2009) Radiation exposure to the orthopaedic surgeon during periacetabular osteotomy. Int Orthop 33(6):1747CrossRefPubMed
67.
go back to reference Akins R, Abdelgawad AA, Kanlic EM (2012) Computer navigation in orthopedic trauma: safer surgeries with less irradiation and more precision. J Surg Orthop Adv 21(4):187–197CrossRefPubMed Akins R, Abdelgawad AA, Kanlic EM (2012) Computer navigation in orthopedic trauma: safer surgeries with less irradiation and more precision. J Surg Orthop Adv 21(4):187–197CrossRefPubMed
Metadata
Title
The use of ionising radiation in orthopaedic surgery: principles, regulations and managing risk to surgeons and patients
Authors
Mohsen Raza
James Houston
Ryan Geleit
Rachel Williams
Alex Trompeter
Publication date
01-07-2021
Publisher
Springer Paris
Published in
European Journal of Orthopaedic Surgery & Traumatology / Issue 5/2021
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-021-02955-9

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