Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT.
J Arthroplasty. 2022 Aug;37(8):1464-1469. doi: 10.1016/j.arth.2022.02.095. Epub 2022 Mar 2.
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.
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.
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.
术中透视是协助骨科医生准确、安全植入硬件的重要工具。在关节置换病例中，随着直接前入路（DA）在全髋关节置换术（THA）中越来越受欢迎，其使用也在增加。然而，电离辐射的暴露对外科医生构成了潜在的健康风险。虽然术中透视在 DA-THA 中的益处变得越来越清晰，并在文献中有详细描述，但与长期累积辐射暴露相关的潜在健康危险却很少被讨论。
在本文中，我们回顾了可用的文献，重点讨论了骨科的辐射安全性，特别是全关节置换术。我们介绍了辐射的基础科学，讨论了骨科手术中的辐射暴露量，并回顾了与长期暴露相关的潜在健康风险。
总的来说，关节置换外科医生的辐射剂量暴露是低的，并且在职业暴露限制的建议范围内。然而，由于电离辐射的随机健康影响，不存在真正安全的辐射暴露阈值剂量。因此，外科医生必须练习适当的透视安全习惯，例如佩戴适当的防护设备、尽量减少透视时间和放大倍数、并尽量使自己与辐射源保持最大距离，以尽量减少终生累积的辐射暴露和相关的健康风险。
