Healthcare workers in the operating room are exposed to radiation during a multitude of surgical procedures as visualisation may be required in orthopaedics, neurology, urology and cardiothoracic surgery. New technologies and techniques have allowed clinicians to perform complex diagnostic and interventional procedures. Exposure to radiation in the operating room often occurs during the taking of standard x-rays and during fluoroscopy, often incorporating the use of a C-arm.
Medical radiography is a broad term used to describe the process of visualisation of the internal parts of the body using x-ray techniques. During a radiographic procedure, an x-ray beam is passed through the body. Fluoroscopy on the other hand is a type of medical imaging that shows a continuous X-ray image on a monitor, much like an X-ray ‘movie’ in essence. In order to perform these types of surgery the patient must be placed on a suitable operating table that allows for radiolucency.
A hybrid operating room is a surgical theatre that is equipped with an appropriate theatre table and advanced medical imaging devices such as fixed C-Arms, CT scanners or MRI scanners. These imaging devices enable minimally-invasive surgery, which is less traumatic for the patient.
It has been estimated that in 1990 there were approximately 1.7 billion procedures performed involving the use of radiation and that increased to 4 billion in 2007. There has been more radiation deaths associated with medical uses than any other including Chernobyl. The risks of radiation exposure include developing a radiation induced cancer or cataracts, and disturbing the growth of a foetus in the case of a pregnant healthcare worker. During fluoroscopy there is a risk that the patient could sustain skin and underlying tissue injuries (burns).
It stands to reason that operating theatre personnel should embrace all possible techniques to protect themselves (and the patient) from over exposure to radiation.
How to protect yourself
- Always employ the ALARA principle (as low as reasonably achievable): simply put use the lowest radiation dose for the shortest time to achieve the required result
- Keep your distance: if possible stand 1.8m away from the radiation
- Keep the x-ray tube under the operating table: this reduces radiation scatter
- Wear protective clothing: this includes lead aprons, thyroid shield and lead glasses
- Always wear your dosimeter
- If you are wearing eye protection and thyroid protection, wear the dosimeter under your lead apron at waist height
- If you are not wearing eye protection and thyroid protection wear your dosimeter outside the apron at collar level
References:
- www.fda.gov/Radiation-EmittingProducts/…/MedicalImaging/…/ucm115354.htm
- http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/ucm175028.htm
- https://web.stanford.edu/dept/EHS/prod/researchlab/radlaser/Hospital_Guidance_document.pdf
- Le Heron, J. Padovani, R. Smith, I. Czarwinski, R. 201. Radiation protection of medical staff. European Journal of Radiology, 76, 20-23.