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Khan J, Khalid B, Abbasi MZ, Ashraf RA, Asghar K, Nadeem Kashmiri M, Tousif K, Shahzad F, Basit J, Haider T, Shabbir H, Rauf Khalid A, Saeed S. Enhancing Radiation Safety Culture: Investigating the Mediating Role of Awareness Among Orthopedic Doctors and Operation Theatre Assistants. Cureus 2023; 15:e41704. [PMID: 37575722 PMCID: PMC10414285 DOI: 10.7759/cureus.41704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION The increasing use of minimally invasive orthopedic procedures has led to a greater reliance on fluoroscopy, resulting in elevated radiation exposure for surgeons. This study aimed to evaluate the knowledge, awareness, and daily practices of orthopedic surgeons regarding radiation safety in an academic hospital. Understanding radiation safety is crucial to minimize patient exposure and prevent adverse effects on surgeons. METHODS This cross-sectional study was conducted at the Department of Orthopedics of different tertiary care hospitals in Rawalpindi, Pakistan. Data were collected prospectively for two years, and a total of 505 participants, including residents, consultants, and operation theatre assistants, completed a questionnaire. The questionnaire was validated by experts and covered information on fluoroscopy usage, frequency of surgeries, awareness of radiation safety, and protective measures. Ethical approval was obtained, and data were analyzed using SPSS version 26.0. RESULTS The majority of participants were male (74.1%), and the sample included various ranks of orthopedic surgeons. Only 56.2% of participants were aware of the usage of fluoroscopy, and 40.2% had read some research on the topic. While 44.6% used lead aprons for radiation protection, the usage of other protective measures and dosimeters was limited. The mediation analysis showed an insignificant indirect association between the rank of orthopedic surgeons, number of surgeries performed, and fluoroscopy usage as a mediator. Awareness and reading research on fluoroscopy were significantly associated with radiation protection. CONCLUSION The knowledge, awareness, and daily practices of orthopedic surgeons regarding radiation safety in fluoroscopy use need improvement. The findings emphasize the importance of implementing training programs, providing radiation protection devices, and ensuring compliance with safety guidelines.
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Affiliation(s)
- Junaid Khan
- Orthopaedic Surgery, Benazir Bhutto Hospital, Rawalpindi, PAK
| | - Bilal Khalid
- Orthopaedic Surgery, Benazir Bhutto Hospital, Rawalpindi, PAK
| | | | | | - Kamran Asghar
- Orthopaedic Surgery, Fauji Foundation Hospital, Rawalpindi, PAK
| | | | - Kashif Tousif
- Medicine, Rawalpindi Medical University, Islamabad, PAK
| | - Faizan Shahzad
- Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Jawad Basit
- Cardiology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Tehseen Haider
- Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | | | | | - Sajeel Saeed
- Cardiology, Rawalpindi Medical University, Rawalpindi, PAK
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Ong CB, Chiu YF, Premkumar A, Gonzalez Della Valle A. Use of a novel imageless navigation system reduced fluoroscopy exposure and improved acetabular positioning in anterior approach total hip arthroplasty: a case-control study. Arch Orthop Trauma Surg 2023; 143:2739-2745. [PMID: 35776176 DOI: 10.1007/s00402-022-04520-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/12/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Direct anterior approach (DAA) for total hip arthroplasty (THA) frequently utilizes fluoroscopy. The purpose of this study is to assess the impact of using a novel, imageless THA navigation system on radiation exposure and acetabular cup placement consistency. MATERIALS AND METHODS This was a retrospective, single-surgeon cohort study of a consecutive group of patients who underwent DAA THA for osteoarthritis. An optic-based imageless navigation system was used to determine intraoperative acetabular inclination and anteversion angles referenced off of a generic coronal and sagittal plane in 71 cases (study group). These were compared with 71 manual cases (control group) for fluoroscopy exposure, operative duration, and acetabular placement variation. Cohorts were similar in their distributions of sex, race, ethnicity, and body mass index. Comparisons between groups were made using independent samples t tests. Alpha error was 0.05. RESULTS Study patients experienced significantly less fluoroscopy exposure time {3.59 [Standard Deviation (SD) 1.95] vs. 9.15 (SD 5.98) seconds; p < 0.001} and dosage (0.30 [SD 0.23] vs. 0.78 [SD 0.63] mGy; p < 0.001). Study and control patients had similar operative times [82.69 (SD 11.70) vs. 89.54 (SD 14.60) minutes; p = 0.09]. The study group had a significantly lower radiographic variation for inclination and anteversion, based on mean proximity to the centroid of each cohort [3.55 (SD 1.88) vs. 5.39 (SD 3.51); p < 0.001] and also a greater proportion of cases that fell within 1 SD of the mean cohort inclination and anteversion (40.8% vs. 21.1%; p = 0.009). CONCLUSIONS Use of a novel imageless navigation system for DAA THA significantly reduced fluoroscopic radiation exposure and improved consistency in acetabular cup placement.
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Affiliation(s)
- Christian B Ong
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - Yu-Fen Chiu
- Department of Biostatistics, Hospital for Special Surgery, New York, NY, USA
| | - Ajay Premkumar
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
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Yakkanti RR, Sedani AB, Syros A, Aiyer AA, D’Apuzzo MR, Hernandez VH. Prevalence and Spectrum of Occupational Injury Among Orthopaedic Surgeons: A Cross-Sectional Study. JB JS Open Access 2023; 8:JBJSOA-D-22-00083. [PMID: 36733707 PMCID: PMC9886518 DOI: 10.2106/jbjs.oa.22.00083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Orthopaedic surgeons are at increased risk for many occupational hazards, both physical and mental. The aim of this study was to evaluate a wide range of work-related injuries among orthopaedic surgeons in the United States. Methods An electronic survey was developed to assess both physical and mental occupational hazards among orthopaedic surgeons. Descriptive statistics were analyzed for all survey items and compared using chi-square and paired t tests, as appropriate. Results The 1,645 responding orthopaedic surgeons (7% response rate) reported a total of 2,702 work-related musculoskeletal injuries, 17.9% of which required surgical treatment. Of the 61 who filed a disability claim, only 66% returned to work and 34% retired early. Additionally, 17.4% of respondents reported having been diagnosed with cancer since starting practice, and 93.8% reported experiencing a finger stick at some point in their career. Over one-half (55.8%) had experienced feelings of psychological distress since beginning practice, and nearly two-thirds (64.4%) reported burnout from work. Conclusions This study captured a spectrum of occupational injuries that pose longitudinal risks to an orthopaedic surgeon's physical and mental well-being. Our hope is that this analysis of occupational hazards will help to raise awareness among the orthopaedic and medical communities and lead to efforts to reduce these risks. Level of Evidence Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ramakanth R. Yakkanti
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida
| | - Anil B. Sedani
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida
| | - Alina Syros
- Miller School of Medicine, University of Miami, Miami, Florida,Email for corresponding author:
| | - Amiethab A. Aiyer
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, Maryland
| | - Michele R. D’Apuzzo
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida
| | - Victor H. Hernandez
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida
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Al Mohammad B, Gharaibeh M, Al Alakhras M. Knowledge and practice of radiation protection in the operating theater among orthopedic surgeons. J Med Imaging (Bellingham) 2022; 9:066002. [PMID: 36388141 PMCID: PMC9650237 DOI: 10.1117/1.jmi.9.6.066002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2023] Open
Abstract
Purpose Many orthopedic procedures, particularly minimally invasive surgeries that require fluoroscopic imaging, present a radiation exposure risk to the orthopedic surgeon. Surgeons may have a higher risk of developing cancer if they receive significant amounts of radiation. Using personal protective equipment (PPE) and appropriate imaging device positioning, plays an important role in reducing the surgeon's radiation exposure. However, there is a lack of knowledge about the surgeon's radiation safety awareness and practices. Therefore, the aim of this study is to investigate the practices and radiation protection knowledge of orthopedic surgeons in the operating theater. Approach A nationwide survey was conducted from October 2021 to January 2022 to evaluate the radiation protection practices and awareness of orthopedic surgeons in Jordan. Normalized practice and knowledge scores were evaluated through the survey and compared between different groups. Descriptive statistics were used to present the surgeon's practices and radiation protection knowledge. Student's t -test was used to compare the outcomes between surgeons that received radiation protection training and surgeons who did not. Using ANOVA analysis, we compared the score outcomes for all the other variables. Results The surgeons that received radiation protection training had significantly higher practice score 39.6% compared with 31% for the group that did not have training ( p = 0.01 ). No statistically significant difference in the knowledge scores was found between the two groups. Although 91% of the surgeons reported using some kind of PPE, only 5.5% used a dosimeter badge during surgeries. Conclusion There is an obvious deficit in radiation safety training of orthopedic surgeons.
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Affiliation(s)
- Badera Al Mohammad
- Jordan University of Science and Technology, Faculty of Applied Medical Sciences, Allied Medical Sciences Department, Irbid, Jordan
| | - Monther Gharaibeh
- The Hashemite University, Faculty of Medicine, Department of Special Surgery, Zarqa, Jordan
| | - Maram Al Alakhras
- Jordan University of Science and Technology, Faculty of Applied Medical Sciences, Allied Medical Sciences Department, Irbid, Jordan
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Jecklin S, Jancik C, Farshad M, Fürnstahl P, Esfandiari H. X23D-Intraoperative 3D Lumbar Spine Shape Reconstruction Based on Sparse Multi-View X-ray Data. J Imaging 2022; 8:271. [PMID: 36286365 PMCID: PMC9604813 DOI: 10.3390/jimaging8100271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/07/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Visual assessment based on intraoperative 2D X-rays remains the predominant aid for intraoperative decision-making, surgical guidance, and error prevention. However, correctly assessing the 3D shape of complex anatomies, such as the spine, based on planar fluoroscopic images remains a challenge even for experienced surgeons. This work proposes a novel deep learning-based method to intraoperatively estimate the 3D shape of patients' lumbar vertebrae directly from sparse, multi-view X-ray data. High-quality and accurate 3D reconstructions were achieved with a learned multi-view stereo machine approach capable of incorporating the X-ray calibration parameters in the neural network. This strategy allowed a priori knowledge of the spinal shape to be acquired while preserving patient specificity and achieving a higher accuracy compared to the state of the art. Our method was trained and evaluated on 17,420 fluoroscopy images that were digitally reconstructed from the public CTSpine1K dataset. As evaluated by unseen data, we achieved an 88% average F1 score and a 71% surface score. Furthermore, by utilizing the calibration parameters of the input X-rays, our method outperformed a counterpart method in the state of the art by 22% in terms of surface score. This increase in accuracy opens new possibilities for surgical navigation and intraoperative decision-making solely based on intraoperative data, especially in surgical applications where the acquisition of 3D image data is not part of the standard clinical workflow.
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Affiliation(s)
- Sascha Jecklin
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Carla Jancik
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Hooman Esfandiari
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
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Estimation of annual effective doses to orthopedic surgeons and nurses as a result of interventional procedures’. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Are Indian orthopaedic surgeons aware of the health hazards of radiation exposure? A survey and review on awareness and ways to mitigate them. J Clin Orthop Trauma 2022; 32:101982. [PMID: 35996382 PMCID: PMC9391582 DOI: 10.1016/j.jcot.2022.101982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022] Open
Abstract
BACKGROUND Standardized education on the short and long-term health hazards of radiation and thus the awareness regarding current radiation exposure limits is restricted in the field of orthopaedics. There is a lack of awareness regarding the risks related to radiation exposure amongst orthopaedic surgeons and therefore the recommended safety precautions to assess and mitigate these potential risks should be emphasized. Orthopaedic surgeons should adopt the ALARA (as low as reasonably achievable) principle. All precautions should be taken to keep all members of the operation room safe from radiation exposure and safeguard patients too. METHODS The survey questionnaire developed in consult with senior orthopaedic surgeons and radiation protection officer consisting of 27 questions was conducted among the orthopaedic surgeons and resident doctors. RESULTS 15% responders were unaware about risks of radiation exposure in routine orthopaedic surgery and 82% unaware of the recommended yearly allowance per individual. 30% responders were unaware of correct positioning of the C-arm and 44% were unaware regarding the same distance to be maintained from the C-arm to reduce radiation exposure. 27% responders were unaware regarding pulsed fluoroscopy and its benefits. 45% responders were unsure regarding the thickness of the lead apron. 83% never use a thyroid gland shield and none of the responders use leaded eye glasses. Only 11% responders use lead badges for documentation of radiation exposure. CONCLUSION Orthopaedic surgeons should understand the basics and basis of radiation exposure limits, be familiar with this literature on the incidence of tumors, dermatitis, cancer risk and cataracts and understand the current intraoperative fluoroscopy safety recommendations. The damaging effects to human tissue caused by radiation exposure are documented since the first reports regarding use of radiographs, hence emphasis on radiation safety and protection should be universally incorporated into graduate medical education.
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Daryoush JR, Lancaster AJ, Frandsen JJ, Gililland JM. Occupational Hazards to the Joint Replacement Surgeon: Radiation Exposure. J Arthroplasty 2022; 37:1464-1469. [PMID: 35247485 DOI: 10.1016/j.arth.2022.02.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/22/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Intraoperative fluoroscopy is an essential tool to assist orthopedic surgeons in accurately and safely implanting hardware. In arthroplasty cases, its use is on the rise with the increasing popularity of the direct anterior (DA) approach for THA. However, exposure of ionizing radiation poses a potential health risk to surgeons. While the benefits of intraoperative fluoroscopy in DA THA is becoming clearer, and are well-described in the literature, the potential health dangers associated with career-long cumulative radiation exposure are rarely discussed. METHODS In this article, we review the available literature to discuss radiation safety in orthopedics with a focus on total joint arthroplasty. We present the basic science of radiation, discuss the amount of radiation exposure in orthopedic surgery, and review the potential health risks associated with long-term exposure. CONCLUSION Overall, the radiation dose exposure to arthroplasty surgeons is low and within recommendations for occupation exposure limits. However, due to the stochastic health impacts of ionizing radiation, there is no threshold dose below which radiation exposure is truly safe. Therefore, it is imperative that surgeons practice proper fluoroscopy safety habits, such as wearing proper protective equipment, minimizing fluoroscopy time and magnification, and maximizing distance from the radiation source to minimize the life-long cumulative radiation exposure and associated health risks.
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Affiliation(s)
- Joshua R Daryoush
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Alex J Lancaster
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Jeffrey J Frandsen
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
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Martínez-Ayora A, Cuervas-Mons M, Fajardo-Ruiz A, Rodríguez-López T, Vaquero J, Sanz-Ferrando L. Ultrasound-guided distal minimally invasive metatarsal osteotomies (US-DMMO): A cadaveric study about its safety and accuracy. Foot Ankle Surg 2022; 28:445-449. [PMID: 34465522 DOI: 10.1016/j.fas.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/28/2021] [Accepted: 08/23/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Distal minimally invasive metatarsal osteotomies have become increasingly popular. This technique requires fluoroscopic control, but recently, an ultrasound-guided procedure has been described. The aim of this anatomical study was to assess the quality safety of ultrasound-guided minimally invasive metatarsal osteotomies. METHODS Ultrasound-guided distal minimally invasive metatarsal osteotomies were performed in 9 cadaveric pieces. The location of the osteotomy, its angulation, and the adjacent anatomical structures injuries was evaluated RESULTS: Thirty-six osteotomies were performed. The osteotomy was metaphyseal in 97.2% of the cases, the average angulation was 47.67° (±4.49, 40-59°) and the average distance to the articular cartilage was 3.22 mm (±1.27, 1-7 mm). One osteotomy (2.8%) was intraarticular and there was one joint capsule lesion (2.8%). The failure, the extreme point distance and angulation values, and the joint capsule injury correspond to a fifth metatarsal. CONCLUSIONS The ultrasound-guided technique is safe and allows a correct location and angulation of the osteotomies.
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Affiliation(s)
- Alvaro Martínez-Ayora
- Department of Orthopaedics and Trauma Surgery, Torrejón University Hospital, C/Mateo Inurria. 28850, Torrejón de Ardoz, Madrid, Spain.
| | - Manuel Cuervas-Mons
- Department of Orthopaedics and Trauma Surgery, 'Gregorio Marañon' University Hospital, C/Dr. Esquerdo 46, 28007, Madrid, Spain
| | - Ana Fajardo-Ruiz
- Department of Orthopaedics and Trauma Surgery, Torrejón University Hospital, C/Mateo Inurria. 28850, Torrejón de Ardoz, Madrid, Spain
| | - Tamara Rodríguez-López
- Department of Orthopaedics and Trauma Surgery, Torrejón University Hospital, C/Mateo Inurria. 28850, Torrejón de Ardoz, Madrid, Spain
| | - Javier Vaquero
- Department of Orthopaedics and Trauma Surgery, 'Gregorio Marañon' University Hospital, C/Dr. Esquerdo 46, 28007, Madrid, Spain
| | - Luis Sanz-Ferrando
- Department of Orthopaedics and Trauma Surgery, Torrejón University Hospital, C/Mateo Inurria. 28850, Torrejón de Ardoz, Madrid, Spain
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Mohebbi Z, Ershadpoor R, Ostovari M, Rakhshan M. Radiation Protection Capability of Operating Room Personnel: Development and Psychometric Properties of a Questionnaire. J Biomed Phys Eng 2021; 11:603-612. [PMID: 34722405 PMCID: PMC8546165 DOI: 10.31661/jbpe.v0i0.2008-1161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/20/2020] [Indexed: 11/20/2022]
Abstract
Background: Radiation protection is an important principle in some wards of the hospital such as radiology, catheterization laboratory and operating room.
Due to the increasing use of radiation in the operating room, there is a need to design an accurate and appropriate tool to evaluate the radiation protection capability of operating room personnel. Objective: This study aims to test the psychometric properties of a questionnaire on radiation protection capability. Material and Methods: This cross-sectional study was conducted in two stages. The first stage was designing items based on the review of available literature,
and the second stage was measuring the validity and reliability of the questionnaire using face validity and content validity Content Validity Index (CVI)
and Content Validity Ratio (CVR). Then the questionnaire was filled out by 200 operating room nurses to evaluate the construct validity by Principal
Component Analysis method. Reliability of the questionnaire was evaluated by test–retest and Cronbach’s alpha analysis method. Results: Due to the results, test–retest correlation coefficient was 0.912, and Cronbach’s alpha coefficient was 0.824, indicating a desirable internal consistency. Conclusion: This study introduces a valid and reliable questionnaire for evaluating the radiation protection capability of operating room nurses.
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Affiliation(s)
- Zinat Mohebbi
- PhD, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Roya Ershadpoor
- MSc, Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Ostovari
- PhD, Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahnaz Rakhshan
- PhD, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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John AT, Madhuri V. A Preliminary Survey of Women Orthopaedic Surgeons on Awareness of Radiation Safety Practice and Breast Cancer Risk in India. Indian J Orthop 2021; 56:452-456. [PMID: 35251509 PMCID: PMC8854465 DOI: 10.1007/s43465-021-00524-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/13/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To assess women surgeons' awareness of radiation protection protocols, cumulative dose, safety measures, radiation exposure, and breast cancer risk in India. METHODS The data were acquired through a survey monkey questionnaire circulated to women orthopaedic surgeons across the country through the WOICE group, e-mails and phone. The questionnaire assessed the respondents' awareness of radiation protection measures and level of exposure. Medical history on breast cancer during their professional life, time of diagnosis, and radiation exposure were collected. Data were analysed and expressed as percentages. RESULTS Fifty-one women orthopaedic surgeons responded. These were sub-grouped into early and late-career group based on whether they had worked in orthopaedics for less than 10 years (n = 33) or 10 or more years (n = 18). The mean number of years of practice of the respondents was 8.1 years, and for the group with 10 or more years was 18.7 years. 90.2% reported compliance to the lead shield, while 9.8% (n = 5) were non-compliant because of the shield's weight. Of the included respondents, 88.8% are currently working. Among all the respondents, only 13.7% (n = 7) use a radiation dosimeter. Not surprisingly, 88.2% (n = 45) of all respondents were unaware of the total radiation exposure received. Two surgeons in the more than 10-year practice category reported a history of breast carcinoma. CONCLUSIONS This preliminary report suggested a need for more awareness of radiation protection measures among women orthopaedic surgeons. Hence, along with the practice of wearing a lead gown, use of lightweight shield, awareness on exposure measure and use of radiation dosimeter should be encouraged.
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Affiliation(s)
- Ansu Thankam John
- Department of Orthopaedics, Christian Medical College, Vellore, 632 002 Tamil Nadu India
| | - Vrisha Madhuri
- Department of Paediatric Orthopaedics, Christian Medical College, Vellore, 632 002 Tamil Nadu India
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Raza M, Geleit R, Houston J, Williams R, Trompeter A. Radiation in orthopaedics (RIO) study: a national survey of UK orthopaedic surgeons. Br J Radiol 2021; 94:20210736. [PMID: 34235964 DOI: 10.1259/bjr.20210736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Orthopaedic surgeons have a responsibility to minimise risks of ionising radiation to patients, themselves and staff. This study aims to establish the understanding of radiation practice, legislation and risk by orthopaedic surgeons. METHODS A nationwide online survey of UK-based orthopaedic surgeons was conducted. Participants answered 18 multiple-choice questions assessing level of radiation safety training, basic principles/knowledge of ionising radiation, relevant legislation and operating practice. RESULTS A total of 406 surgeons completed the survey. 92% reported using intraoperative ionising radiation at least once per week. 38% received no formal training on radiation safety. Knowledge of basic principles of radiation and legislation was limited. There was variable knowledge when labelling an image intensifier machine and choosing its safest orientation. Poor uptake of radiation protection equipment was noted. Only 19% agreed they had adequate training in ionising radiation safety and 27% reported receiving adequate training in equipment emitting ionising radiation in the operating theatre. CONCLUSION Many orthopaedic surgeons in the UK do not believe they are adequately trained in radiation safety. There is a deficiency amongst practicing surgeons in basic knowledge, relevant legislation and practicalities of the use of ionising radiation in the operating room. This could potentially put patients and health-care professionals at additional risk. We recommend that a standardised national training programme on the basic principles and safety of ionising radiation is implemented for all practicing orthopaedic surgeons. ADVANCES IN KNOWLEDGE This paper is the first UK national survey amongst orthopaedic surgeons and is one of the largest reported internationally.
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Affiliation(s)
- Mohsen Raza
- Department of Trauma & Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ryan Geleit
- Department of Trauma & Orthopaedics, Kingston Hospital NHS Foundation Trust, London, UK
| | - James Houston
- Department of Trauma & Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Rachel Williams
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Alex Trompeter
- Department of Trauma & Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
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The use of ionising radiation in orthopaedic surgery: principles, regulations and managing risk to surgeons and patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:947-955. [PMID: 33825954 DOI: 10.1007/s00590-021-02955-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/21/2021] [Indexed: 12/28/2022]
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.
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Altintas E, Bahceci T, Batur AF, Kaynar M, Kilic O, Akand M, Goktas S, Gul M. A survey analysis of knowledge levels of urologists about radiation safety and fluoroscopy use. Int J Clin Pract 2021; 75:e13862. [PMID: 33237621 DOI: 10.1111/ijcp.13862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/20/2020] [Indexed: 12/23/2022] Open
Abstract
AIMS To evaluate the awareness of the use of fluoroscopy in endourological procedures, as well as the theoretical and practical applications of preventive measures. MATERIAL AND METHOD Between May 2018 and April 2019, a 26-question survey prepared using Google Docs was sent to urologists via email. Personal information, radiation training and behaviours related to radiation and fluoroscopy usage, and the use of protective equipment were queried. RESULTS A total of 226 participants fully completed and returned the email survey. Of the 226 participants, 78 (34.5%) were academics, 44 (19.4%) were residents while 104 (46.1%) were experts. More than 60% of the participants stated that they participated in the operation requiring less than five fluoroscopy use per week. The majority of operations requiring fluoroscopy consisted of endourological procedures. The lead apron was used by 93% of the participants, but the use of protective glasses and gloves was very low (3.5%). The majority of academicians, experts and residents did not use dosimeters (76.9%, 82.7% and 81.8%, respectively). More than 50% of the participants did not have literature information about the harmful effects of radiation with the use of fluoroscopy. The most common complaints on the day of fluoroscopy were fatigue and headache. CONCLUSION The lack of information regarding the radiation protection measures and harmful effects of radiation is common among urologists in Turkey. Therefore, systematic training programs on fluoroscopy use and radiation exposure should be provided during urology residency.
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Affiliation(s)
- Emre Altintas
- Department of Urology, Akcakale State Hospital, Sanliurfa, Turkey
| | - Tuncer Bahceci
- Department of Urology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Ali Furkan Batur
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Mehmet Kaynar
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Ozcan Kilic
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Murat Akand
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Serdar Goktas
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Murat Gul
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
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Skrk D, Petek K, Pekarovic D, Mekis N. Typical air kerma area product values for trauma orthopaedic surgical procedures. Radiol Oncol 2021; 55:240-246. [PMID: 33764702 PMCID: PMC8042827 DOI: 10.2478/raon-2020-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/28/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim of study was to establish the typical radiation quantity values for the most common trauma orthopaedic surgical procedures and to compare them with reference values of equivalent procedures performed in other institutions. In addition, we assess the impact of image intensifier and flat panel detector technology used for fluoroscopically guidance on patient exposure. MATERIALS AND METHODS Five most frequently performed fluoroscopically guided trauma orthopaedic procedures in University Medical Centre Ljubljana were analysed. Data on 199 cases over a 6 months period from December 2016 to June 2017 were gathered retrospectively. Study covered 40 dynamic hip screw fixations (DHS), 23 proximal femoral nail insertions (PFN), 20 proximal humeral nail insertions (PHN), 77 partial hip endoprosthesis implantations (PEP) and 39 percutaneous posterior spine fixations (PPS). The median and average along with the first and third quartile values of air kerma area product (KAP) for each procedure type were calculated as well as median and average value of fluoroscopy screening time. RESULTS Typical KAP value for dynamic hip screw fixation was set at 0.52 Gycm2; for proximal femoral nail insertion at 0.53 Gycm2 and for proximal humeral nail insertion at 0.26 Gycm2. For implantation of partial endoprosthesis typical KAP value utilizing flat panel technology was set at 0.08 Gycm2 and at 0.21 Gycm2 when the image intensifier technology was used. Typical KAP value for percutaneous posterior spine fixation was set at 1.26 Gycm2, using flat panel technology and at 3.98 Gycm2 using image intensifier technology. CONCLUSIONS Established typical KAP levels of surgical orthopaedic procedures in traumatology will serve as a valuable tool for further radiation exposure optimization.
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Affiliation(s)
- Damijan Skrk
- Slovenian Radiation Protection Administration, Ljubljana, Slovenia
| | - Katja Petek
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Dean Pekarovic
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nejc Mekis
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
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16
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Tips, quips and pearls: Ultrasound-guided distal metatarsal minimal invasive osteotomy (US-DMMO). Foot Ankle Surg 2021; 27:30-34. [PMID: 31980385 DOI: 10.1016/j.fas.2020.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/26/2019] [Accepted: 01/12/2020] [Indexed: 02/04/2023]
Abstract
Metatarsalgia is a frequent cause of forefoot pain. Surgical treatment is based on the performance of osteotomies at the level of the minor radii to restore a normal distribution of pressure within the forefoot and improve the biomechanics during gait. In recent years, percutaneous surgery of the foot, and specifically distal metatarsal minimal invasive osteotomy, have proven to be a valid technique, providing satisfactory clinical results, similar to open osteotomy with less soft tissue aggression, but it requires intraoperative fluoroscopy to be performed. This article will present a modification to guide the procedure by ultrasound providing a new option that eliminates radiation and provides greater portability and accessibility.
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Kang S, Cha ES, Bang YJ, Na TW, Lee D, Song SY, Lee WJ. Radiation exposure and fluoroscopically-guided interventional procedures among orthopedic surgeons in South Korea. J Occup Med Toxicol 2020; 15:24. [PMID: 32793295 PMCID: PMC7418415 DOI: 10.1186/s12995-020-00276-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/03/2020] [Indexed: 11/13/2022] Open
Abstract
Background The use of fluoroscopically-guided interventional (FGI) procedures by orthopedic surgeons has been increasing. This study aimed to investigate the occupational radiation exposure among orthopedic surgeons in South Korea. Methods A nationwide survey of orthopedic surgeons was conducted in South Korea in October 2017. The dosimetry data of the participants were obtained from the National Dosimetry Registry. The orthopedic surgeons were categorized by job specialty [spine or trauma specialists, other orthopedic specialists, and residents], and descriptive statistics for the demographics and work-related characteristics were presented. Multivariable logistic regression analysis was used to evaluate the risk factors for the orthopedic surgeons who were not linked with the dosimetry data. Results Among the total participants (n = 513), 40.5% of the orthopedic surgeons spent more than 50% of their time working with the FGI procedures when compared with their overall work. The average frequency of the FGI procedures among the orthopedic surgeons was 12.3 days per month. Less than 30% of the participants were regularly provided with radiation monitoring badges. The proportion of subjects who always wore lead aprons and thyroid shields were 52 and 29%, respectively. The residents group experienced more unfavorable working conditions of radiation exposure than the other specialists. The dosimetry data were not significantly linked among the residents (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.11–3.95) and orthopedic surgeons working at small hospitals (OR 4.76, 95% CI 1.05–21.51). Conclusions Although orthopedic surgeons often performed FGI procedures, they wore protective gear less frequently, and a large proportion of orthopedic surgeons were not monitored by the national radiation dosimetry system. As the number of radiation procedures performed by the orthopedic surgeons increases, more intensive approaches are needed to reduce radiation exposure, especially for spine and trauma surgeons.
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Affiliation(s)
- Seonghoon Kang
- Department of Occupational and Environmental Medicine, COMWEL Ansan Hospital, Korea Workers' Compensation & Welfare Service, Gyeonggi-do, South Korea.,Department of Epidemiology and Health Informatics, Graduate School of Public Health, Korea University, Seoul, South Korea
| | - Eun Shil Cha
- Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 South Korea
| | - Ye Jin Bang
- Department of Epidemiology and Health Informatics, Graduate School of Public Health, Korea University, Seoul, South Korea.,Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 South Korea
| | - Teresa W Na
- Department of Epidemiology and Health Informatics, Graduate School of Public Health, Korea University, Seoul, South Korea.,Department of Policy and Administration, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Dalnim Lee
- Department of Epidemiology and Health Informatics, Graduate School of Public Health, Korea University, Seoul, South Korea.,Department of Radiation Effects Research, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Sang Youn Song
- Department of Orthopedic Surgery, Gyeongsang National University Hospital, Jinju, South Korea
| | - Won Jin Lee
- Department of Epidemiology and Health Informatics, Graduate School of Public Health, Korea University, Seoul, South Korea.,Department of Preventive Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 South Korea
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Pires RE, Reis IGN, de Faria ÂRV, Giordano V, Labronici PJ, Belangero WD. The hidden risk of ionizing radiation in the operating room: a survey among 258 orthopaedic surgeons in Brazil. Patient Saf Surg 2020; 14:16. [PMID: 32336990 PMCID: PMC7175580 DOI: 10.1186/s13037-020-00238-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/03/2020] [Indexed: 11/17/2022] Open
Abstract
Background This study aims to assess orthopaedic surgeon knowledge in Brazil about ionizing radiation and its health implications on surgical teams and patients. Methods A 15-question survey on theoretical and practical concepts of ionizing radiation was administered during the 23rd Brazilian Orthopaedic Trauma Association annual meeting. The survey addressed issues within orthopedic surgery, such as radiation safety concepts, protection, exposure, as well as the participant gender. Participants were either orthopedic surgeons or orthopedic surgery residents working at institutions in Brazil. Results One thousand surveys were distributed at the moment of the meeting registration, and 258 were answered completely (25.8% response rate). Only 5.8% of participants used basic radiation protection equipment; 47.3% used a dosimeter; 2.7% reached the annual maximum permissible radiation dose; 10.5% knew the period of increased risk to fetal gestation; 5.8% knew the maximum permissible radiation dose during pregnancy; 58.5% knew that the hands, eyes, and thyroid are the most exposed areas and at greater risk of radiation-related lesions; 25.2% knew the safe distance from a radiation-emitting tube is 3 m or more; 44.2% knew the safest positioning of the radiation-emitting tube; 25.2% knew that smaller tubes emit greater radiation at the entrance dose to magnify the image; and 55.4% knew that the surgery team receives more scattered radiation in surgical procedures performed on obese patients. Conclusion This study revealed inadequate theoretical and practical knowledge about radiation exposure among orthopaedic surgeons in Brazil. Only a minority of orthopaedic surgeons used basic radiation protection equipment. No significant differences in knowledge were found when comparing all orthopedic surgery specialties. Our findings indicate an urgent need for education to increase knowledge among orthopaedic surgeons about the hazards of ionizing radiation. Personal protection and implementation of the ALARA (as low as reasonably achievable) protocol in daily practice are important behaviors to prevent the harmful effects of ionizing radiation.
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Affiliation(s)
- Robinson Esteves Pires
- 1Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efegênia, Belo Horizonte, MG Brazil
| | - Igor Guedes Nogueira Reis
- 1Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efegênia, Belo Horizonte, MG Brazil
| | - Ângelo Ribeiro Vaz de Faria
- 1Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efegênia, Belo Horizonte, MG Brazil
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ Brazil
| | - Pedro José Labronici
- 3Departamento de Ortopedia e Traumatologia, Universidade Federal Fluminense, Niterói, RJ Brazil
| | - William Dias Belangero
- 4Departamento de Ortopedia e Traumatologia, Universidade Estadual de Campinas (Unicamp), Campinas, SP Brazil
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19
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van Papendorp LWA, Suleman FE, Hanekom H. The knowledge, awareness and practices of radiation safety amongst orthopaedic surgeons. SA J Radiol 2020; 24:1806. [PMID: 32161676 PMCID: PMC7059512 DOI: 10.4102/sajr.v24i1.1806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/11/2020] [Indexed: 11/01/2022] Open
Abstract
Background Fluoroscopic imaging in orthopaedic theatres is increasing, with added risk to the orthopaedic surgeon who is increasingly being exposed to ionising radiation. It is thus crucial for orthopaedic surgeons to have a working knowledge of radiation safety. In spite of these concerns, however, many orthopaedic surgeons do not receive standard training in radiation safety. Objectives The evaluation of orthopaedic surgeons' knowledge, awareness and everyday practices regarding radiation safety in an academic hospital. Methods A questionnaire with multiple-choice-type questions was developed by a panel of experts and used to conduct a descriptive study. The questionnaire had multiple dimensions, each evaluating orthopaedic knowledge, awareness and practices, respectively. The study population included orthopaedic surgeons rotating within the orthopaedic circuit of the University of Pretoria. Results Orthopaedic surgeons regularly make use of fluoroscopic imaging in theatre, with 34 (77%) participants indicating that they use fluoroscopy in more than half of all their procedures performed. Most participants have insufficient knowledge of radiation safety, with the majority failing to correctly answer basic questions on radiation safety. Forty (91%) participants do not wear personal dosimeters, in spite of 39 participants (89%) believing that they are vulnerable to adverse effects. Basic radiation protection devices are underutilised, with 32 (73%) participants indicating that they have not received adequate training in radiation safety. Conclusion The majority of orthopaedic surgeons regularly use fluoroscopic imaging in theatre yet lack in-depth knowledge and awareness regarding radiation safety associated with this imaging modality. Implementation of a radiation safety training programme is thus recommended.
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Affiliation(s)
- Louis W A van Papendorp
- Department of Radiology, Faculty of Health Sciences, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Farhana E Suleman
- Department of Radiology, Faculty of Health Sciences, University of Pretoria and Kalafong Hospital, Pretoria, South Africa
| | - Heleen Hanekom
- Department of Radiology, Faculty of Health Sciences, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
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Abstract
» The damaging effects to human tissue caused by radiation exposure have been documented since the first reports regarding use of radiographs in the late nineteenth century.
» Orthopaedic surgeons and residents often are undereducated about the risks associated with radiation exposure and the recommended safety precautions to help mitigate these potential risks.
» Orthopaedic surgeons need to adopt the ALARA (as low as reasonably achievable) principle: whenever possible, all available precautions should be taken to keep all members of the operating room safe from radiation exposure while emphasizing the best appropriate care for patients.
» An emphasis on radiation safety and protection should be universally incorporated into graduate medical education.
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Affiliation(s)
- Nicholas Frane
- Zucker School of Medicine at Hofstra and Northwell Plainview Hospital, Plainview, New York
| | - Andrew Megas
- Zucker School of Medicine at Hofstra and Northwell Plainview Hospital, Plainview, New York
| | - Erik Stapleton
- Zucker School of Medicine at Hofstra and Northwell Plainview Hospital, Plainview, New York
| | - Maximillian Ganz
- Zucker School of Medicine at Hofstra and Northwell Plainview Hospital, Plainview, New York
| | - Adam D Bitterman
- Zucker School of Medicine at Hofstra and Northwell Plainview Hospital, Plainview, New York
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21
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Fidan F, Çetin MÜ, Kazdal C, Kılıç F, Özkaya U. Behaviour and knowledge skill levels of orthopedic surgeons about radiation safety and fluoroscopy use: A survey analysis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:301-305. [PMID: 31079996 PMCID: PMC6739260 DOI: 10.1016/j.aott.2019.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 02/23/2019] [Accepted: 04/23/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the behaviour and knowledge skill levels of Turkish orthopedic surgeons about fluoroscopy usage and radiation safety. METHODS The questionnaire, consisting of nineteen questions, was sent to orthopaedic surgeons and requested by a total of 323 surgeons online. The questions were about personal information, training and behaviours related to radiation and fluoroscopy usage, and the use of protective equipment. RESULTS A total of 277 individuals completed the questionnaire. The answers of 180 surgeons whose working duration was more than 1 year and also who participated in at least one fluoroscopy requiring operation per week, were analysed. 22 (12%) participants answered that they were trained on fluoroscopy usage. Sixty people (33.3%) reported that they did not use any protective equipment regularly. The most commonly used protection methods were lead aprons 123 (68.3%). Thyroid protectors were used by 92 participants (52.1%). There was no significant difference between the groups when comparing the use of protective equipment according to the academic title. Only 19 (10.6%) of the surgeons noted that they used dosimeter regularly, and 15 (83.3%) of them reported that they controlled their dosimeters. CONCLUSION In this study, Orthopedic surgeons were found not to be adequately trained about use and risks of fluoroscopy and also not to be equipped about methods for preventing radiation damage.
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Affiliation(s)
- Fırat Fidan
- Sancaktepe Şehit Prof.Dr.İlhan Varank Eğitim ve Araştırma Hastanesi, İstanbul, Turkey.
| | - Mehmet Ümit Çetin
- Tekirdağ Namık Kemal üniversitesi Ortopedi veTravmatoloji Anabilim Dalı, Tekirdağ, Turkey.
| | - Cengiz Kazdal
- Gaziosmanpaşa Taksim Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, İstanbul, Turkey.
| | - Feyzi Kılıç
- Gaziosmanpaşa Taksim Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, İstanbul, Turkey.
| | - Ufuk Özkaya
- Memorial Bahçelievler Hastanesi, İstanbul, Turkey.
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Cheon BK, Kim CL, Kim KR, Kang MH, Lim JA, Woo NS, Rhee KY, Kim HK, Kim JH. Radiation safety: a focus on lead aprons and thyroid shields in interventional pain management. Korean J Pain 2018; 31:244-252. [PMID: 30310549 PMCID: PMC6177538 DOI: 10.3344/kjp.2018.31.4.244] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/26/2018] [Accepted: 06/18/2018] [Indexed: 12/19/2022] Open
Abstract
C-arm fluoroscopy is useful equipment in interventional pain management because it helps to guide correct needle targeting for the accurate injection and drug delivery. However, due to increased use of C-arm fluoroscopy in various pain procedures, the risk of radiation exposure is a significant concern for pain physicians. The harmful biological effects of ionizing radiation on the human body are well known. It is therefore necessary to strive to reduce radiation exposure. Lead aprons with thyroid shields are the most fundamental radiation protective devices for interventional procedures, and are very effective. However, the operator's radiation safety cannot be guaranteed because pain physicians seem to lack sufficient interest, knowledge, and awareness about radiation safety. Also, inappropriate care and use of radiation protective devices may result in a higher risk of radiation exposure. The purpose of this article was to review the literature on radiation safety with a focus on lead aprons and thyroid shields and present recommendations related to those devices during C-arm fluoroscopic-guided interventions by pain physicians.
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Affiliation(s)
- Bo Kyung Cheon
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Cho Long Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Ka Ram Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Min Hye Kang
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jeong Ae Lim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Nam Sik Woo
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Ka Young Rhee
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hae Kyoung Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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Falavigna A, Ramos MB, Wong CC, Barbagallo G, Brodke D, Al-Mutair A, Ghogawala Z, Riew KD. Commentary: Worldwide Knowledge and Attitude of Spine Surgeons Regarding Radiation Exposure. Neurosurgery 2018; 83:E153-E161. [DOI: 10.1093/neuros/nyy243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Asdrubal Falavigna
- Department of Neurosurgery, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
- Laboratory of Clinical Studies and Basic Models on Spinal Cord Pathologies, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | - Miguel Bertelli Ramos
- Laboratory of Clinical Studies and Basic Models on Spinal Cord Pathologies, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | - Chung Chek Wong
- Department of Orthopedic Surgery, Sarawak General Hospital, Jalan Tun Ahmad Zaidi Adruce, Kuching, Malaysia
| | - Giuseppe Barbagallo
- Department of Neurosurgery, Policlinico “G. Rodolico” University Hospital, Catania, Italy
| | - Darrel Brodke
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Abdulaziz Al-Mutair
- Alrazi Hospital, Ministry of Health/Kuwait Institute for Medical Specialization, Adailiya, Kuwait
| | - Zoher Ghogawala
- Alan and Jacqueline Stuart Spine Center, Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - K Daniel Riew
- The Och Spine Hospital, Department of Orthopedic Surgery, Columbia University, New York, New York
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Knowledge and Attitude Regarding Radiation Exposure Among Spine Surgeons in Latin America. World Neurosurg 2018; 112:e823-e829. [DOI: 10.1016/j.wneu.2018.01.166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 01/21/2018] [Accepted: 01/22/2018] [Indexed: 11/19/2022]
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