Radiation exposure of trainee anaesthetists

Radiation Exposure of Anaesthetists Visualised by Real-time Dosimetry

BACKGROUND

Chronic exposure to occupational ionising radiation is seen as one reason for elevated cancer prevalence.

OBJECTIVE

The aim of this retrospective study was to evaluate radiation exposure of anaesthetists by real-time dosimetry.

METHODS

Data of 296 patients were analyzed. Ten types of trauma operation procedures including osteosynthesis of upper and lower extremity fractures and minimally invasive stabilisation of traumatic and osteoporotic vertebral fractures were accomplished. Evaluation was performed by an occupational dosimetry system, which visualises anaesthetists radiation exposure feedback compared to surgeons in real-time.

RESULTS

A significantly lower radiation exposure to anaesthetists compared to surgeons was observed in four types of operative procedures: Plate fixation of proximal humerus fractures, osteosynthesis of proximal femoral fractures, stabilisation of traumatic and osteoporotic vertebral fractures. In four types of operations (plate osteosynthesis of proximal humeral, distal radial and tibial fractures and intramedullary nailing of the clavicle), anaesthetists` amount of radiation exceeded one-third of the surgeons' exposure, especially if the C-arm tube was positioned close to the anaesthetists work station at the patients' head.

CONCLUSION

By using the occupational radiation dose monitoring system, radiation exposure to anaesthetists was visualised in real-time during trauma operations. Radiation exposure of anaesthetists depends on the type of operation and the position of the C-arm. The system may help to increase anaesthetists` awareness concerning radiation exposure and to enhance compliance in using radiation protection techniques.

Behaviour and knowledge skill levels of orthopedic surgeons about radiation safety and fluoroscopy use: A survey analysis

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.

Evaluation of Radiation Exposure Pattern and Radiation Absorbed Dose Resulting from Occupational Exposure of Anesthesiologists to Ionizing Radiation

INTRODUCTION

Little information is available concerning the radiation exposure of anesthesiologists, and no such data have previously been collected in Iran. This prospective study was performed to determine the amount of radiation exposure of anesthesiologists for the purpose of assessing whether or not dangerous levels of radiation exposures were being reached, and to identify factors that correlate with excessive risk.

PARTICIPANTS AND METHODS

The radiation exposure of all anesthesiology residents and the attending of Shiraz University of Medical Sciences during a 3-month period (from June to August 2016) was measured using a film badge with monthly readings. Physicians were divided into two groups: group 1 (the ones assigned to ORs with radiation exposure), and group 2 (the ones assigned to ORs with no or minimal radiation exposure).

RESULTS

A total number of 10744 procedures were performed in 3 major university hospitals including 353 cases of pediatric angiography, 251 cases of percutaneous nephrolithotomy, 43 cases of chronic pain palliation and 672 cases of orthopedic surgeries with C-arm application. In all 3 months, there were statistically significant differences in the amount of radiation exposure between the two groups.

CONCLUSION

Anesthesiologists working in the cardiac catheterization laboratory, pain treatment service, orthopedic and urologic ORs are exposed to statistically significantly higher radiation levels compared to their colleagues in other ORs. The radiation exposure to anesthesiologists can rise to high levels; therefore, they should get proper teaching, shielding and periodic evaluations.

Risk and safety concerns in anesthesiology practice: The present perspective

Newer developments and advancements in anesthesiology, surgical, and medical fields have widened the functional scope of anesthesiologist thus increasing his professional responsibilities and obligations. While at workplace, anesthesiologist is exposed to a wide array of potential hazards that can be detrimental to his overall health. Numerous risks and safety concerns have been mentioned in the literature, but the magnitude of challenges in anesthesiology practice are far greater than those cited and anticipated. Many times these challenging situations are unavoidable and the attending anesthesiologist has to deal with them on an individual basis. These hazards not only affect the general health but can be extremely threatening in various other ways that can increase the potential risks of morbidity and mortality. This article is an attempt to bring a general awareness among anesthesia fraternity about the various health hazards associated with anesthesia practice. Also, a genuine attempt has been made to enumerate the various preventive methods and precautions that should be adopted to make practice of anesthesiology safe and smooth.

Use of digital dosemeters for supporting staff radiation safety in paediatric interventional radiology suites

Modern-day interventional radiology (IR) procedures impart a wide range of occupational radiation doses to team members. Unlike thermoluminescent badges, digital dosemeters provide real-time dose readings, making them ideal for identifying different components during IR procedures, which influence staff radiation safety. This study focused solely on paediatric IR (PIR) cases. Digital dosemeters measured the impact of imaging modality, shielding, patient and operator specific factors, on the radiation dose received during various simulated and real live PIR procedures. They recorded potential dose reductions of 10- to 100-fold to each staff member with appropriate use of shielding, choice of imaging method, staff position in the room and complex interplay of other factors. The digital dosemeters were well tolerated by staff. Results highlight some unique radiation safety challenges in PIR that arise from dose increases with magnification use and close proximity of staff to the X-ray beam.

Diagnostic reference levels for X-ray investigations in pain management units in Belgium

X-rays are commonly used in pain treatment centres where infiltrative techniques are performed. Although X-rays are useful in increasing the precision of infiltrative techniques, their use puts patients and staff at risk of radiation exposure. As a result, medical staff now have to obtain a certificate of training on the use of X-rays before being allowed to use X-rays in practice. This analysis was based on 373 detailed registrations of procedure-related parameters in the six centres that participated in this study between January 2009 and July 2009. Examinations chosen for inclusion in this study were the most commonly performed fluoroscopic imaging-guided procedures in a pain management unit: epidurals (cervical/lumbar), facet joint nerve blocks (cervical/lumbar) and transforaminal (cervical/lumbar). The sample size, the dose-area product (DAP) range for whole population, the mean and the third quartile DAP corrected for patient size (DAP(corr)), the screening time range, the mean and the third quartile screening time are presented. The proposed DRLs for epidurals, facet joint nerve blocks and transforaminal are 0.5, 2.5 and 3 Gy cm² for DAP values and 12, 60 and 50 s for screening times, respectively. In the absence of national diagnostic reference levels (DRLs) for pain management fluoroscopic procedures, these DAP and screening time values provide a possible way of establishing provisional DRLs for local use. The values for each examination type could be used as a baseline against which to monitor the effectiveness of dose reduction strategies as part of the optimisation process that is the goal of any quality control and patient dose monitoring system.