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Occupational exposure from common fluoroscopic projections used in orthopaedic surgery.

BACKGROUND: Personnel assisting in or performing fluoroscopically guided procedures may be exposed to high doses of radiation. Accurate occupational dosimetric data for the orthopaedic theater staff are of paramount importance for practicing radiation safety. METHODS: Fluoroscopic screening was performed on an anthropomorphic phantom with use of four projections common in image-guided orthopaedic surgery. The simulated projections were categorized, according to the imaged anatomic area and the beam orientation, as (1) hip joint posterior-anterior, (2) hip joint lateral cross-table 45 degrees, (3) lumbar spine anterior-posterior, and (4) lumbar spine lateral 90 degrees. The scattered air kerma rate was measured on a grid surrounding the operating table. For each grid point, the effective dose, eye lens dose, and face skin dose values, normalized over the tube dose area product, were derived. For the effective dose calculations, three radiation protection conditions were considered: (1) with the exposed personnel using no protection measures, (2) with the exposed personnel wearing a 0.5-mm lead-equivalent protective apron, and (3) with the exposed personnel wearing both an apron and a thyroid collar. Maximum permissible workloads for typical hip, spine, and kyphoplasty procedures were derived on the basis of compliance with effective dose, eye lens dose, and skin dose limits. RESULTS: We found that the effective dose, eye lens dose, and face skin dose to an orthopaedic surgeon wearing a 0.5-mm lead-equivalent apron will not exceed the corresponding limits if the dose area product of the fluoroscopically guided procedure is <0.38 Gy m (2). When protective eye goggles are also worn, the maximum permissible dose area product increases to 0.70 Gy m (2), while the additional use of a thyroid shield allows a workload of 1.20 Gy m (2). The effective dose to the orthopaedic surgeon working tableside during a typical hip, spine, kyphoplasty procedure was 5.1, 21, and 250 micro Sv, respectively, when a 0.5-mm lead-equivalent apron alone was used. The additional use of a thyroid shield reduced the effective dose to 2.4, 8.4, and 96 micro Sv per typical hip, spine, and kyphoplasty procedure, respectively. CONCLUSIONS: The levels of occupational exposure vary considerably with the type of fluoroscopically assisted procedure, staff positioning, and the radiation protection measures used. The data presented in the current study will allow for accurate estimation of the occupational dose to orthopaedic theater personnel.

Fluoroscopy↗

Radiation exposure with use of the mini-C-arm for routine orthopaedic imaging procedures.

BACKGROUND: The use of mobile fluoroscopic devices during orthopaedic procedures is associated with substantial concern with regard to the radiation exposure to surgeons and support staff. The perceived increased risks associated with large c-arm devices have been well documented. However, no study to date has documented the relative radiation risk associated with the use of a mini-c-arm device. The purpose of the current study was to determine the amount of radiation received by the surgeon during the use of a mini-c-arm device and to compare this amount with documented measurements associated with the large c-arm device. METHODS: With use of a radiation dosimeter, measurements were carried out with tissue-equivalent anthropomorphic phantoms to quantitatively determine exposure rates at various locations and distances from the mini-c-arm for two common upper and lower extremity procedures. RESULTS: Regardless of position, distance, or relative duration of exposure, exposure rates resulting from the use of the mini-c-arm device were one to two orders of magnitude lower than those reported in the literature in association with the use of the large c-arm device. CONCLUSIONS: The mini-c-arm device should be utilized whenever feasible in order to eliminate many of the concerns associated with use of the large c-arm device, specifically those related to cumulative radiation hazards, positioning considerations, relative distance from the beam, and the need for protective shielding.

Diagnostic Imaging↗

An improved method for estimating the entrance exposure in diagnostic radiographic examinations.

There is currently a widespread consensus on the importance of monitoring patient radiation exposures during radiographic examinations. Diagnostic facilities under federal jurisdiction already legislate maximum patient exposure limits for various diagnostic radiologic examinations, while an increasing number of state legislatures have instituted such regulations. Compliance requires that institutions be capable of assessing each patient's entrance exposures. A method is proposed that would facilitate the acquisition of such patient exposure information in a relatively straightforward and accurate manner, requiring a minimum number of measurements and access to a suitable programmable calculator. A standardized set of exposure measurements obtained on an accurately calibrated three-phase radiographic unit has been fitted by an analytic function. The average accuracy of the fit between the limits of 40-140 kVp and 2.5- to 6.0-mm aluminum filtration was 0.3%. The concept of linear scaling was employed to allow the analytic function to accurately reproduce the exposure outputs of different radiographic units. Validation experiments on patients indicated that an overall accuracy of 10% can be expected when using well-calibrated radiographic equipment. The method described permits institutions to verify their compliance with federal and/or state regulations and to confirm that their radiation exposures are consistent with national averages.

Humans↗

Radiation exposure to personnel in departments of gynaecologic oncology in Sweden.

Radium-226 and cesium-137 are used at six departments of gynaecologic oncology in Sweden. A survey of radiation exposure (dose equivalents) to the personnel is reported. The measurements were performed with TL dosemeters. From dose distribution measurements, the dose equivalents in different parts of the body, related to different working procedures, were determined. Effective dose equivalents and collective dose equivalents were also estimated. The estimated collective dose equivalent for this category of personnel in Sweden was 1.3 manSv. The effective dose equivalent was less than the dose equivalent measured with dosemeters worn on the chest, and was less than half the annual limit set by ICRP.

Brachytherapy↗

Fundamental issues on electromagnetic fields (EMF).

This paper will examine the fundamental principals of Electromagnetic Field Radiation. The discussion will include: The basic physical characteristics of magnetic and electric fields, the numerous sources of EMF in our everyday lives, ways to detect and measure EMF accurately, what to look for in EMF instruments, and the issues and misconceptions on shielding and exposure reduction.

Computer Terminals↗