Massey Patrick A, Myers Mitchell E, Guedry Ryan D, Lowery Michael T, Perry Kevin J, Barton R Shane
Department of Orthopaedic Surgery, Louisiana State University, Shreveport, Louisiana.
School of Medicine, Louisiana State University, Shreveport, Louisiana.
JB JS Open Access. 2022 Mar 21;7(1). doi: 10.2106/JBJS.OA.21.00115. eCollection 2022 Jan-Mar.
Radiation exposure of orthopaedic residents should be accurately monitored to monitor and mitigate risk. The purpose of this study was to determine whether a personalized lead protocol (PLP) with a radiation monitoring officer would improve radiation exposure monitoring of orthopaedic surgery residents.
This was a retrospective case-control study of 15 orthopaedic surgery residents monitored for radiation exposure during a 2-year period (March 2017 until February 2019). During the first 12-month period (phase 1), residents were given monthly radiation dosimeter badges and instructed to attach them daily to the communal lead aprons hanging outside the operating rooms. During the second 12-month period (phase 2), a PLP (PLP group) was instituted in which residents were given lead aprons embroidered with their individual names. A radiation safety officer was appointed who placed the badges monthly on all lead aprons and collected them at the end of the month, whereas faculty ensured residents wore their personalized lead apron. Data collected included fluoroscopy use time and radiation dosimeter readings during all orthopaedic surgeries in the study period.
There were 1,252 orthopaedic surgeries using fluoroscopy during phase 1 in the control group and 1,269 during phase 2 in the PLP group. The total monthly fluoroscopy exposure time for all cases averaged 190 minutes during phase 1 and 169 minutes during phase 2, with no significant difference between the groups (p < 0.45). During phase 1, 73.1% of the dosimeters reported radiation exposure, whereas during phase 2, 88.7% of the dosimeters reported radiation exposure (p < 0.001). During phase 1, the average monthly resident dosimeter exposure reading was 7.26 millirems (mrem) ± 37.07, vs. 19.00 mrem ± 51.16 during phase 2, which was significantly higher (p < 0.036).
Institution of a PLP increased the compliance and exposure readings of radiation dosimeter badges for orthopaedic surgery residents, whereas the actual monthly fluoroscopy time did not change. Teaching hospitals should consider implementing a PLP to more accurately monitor exposure.
应准确监测骨科住院医师的辐射暴露情况，以监测和降低风险。本研究的目的是确定配备辐射监测人员的个性化铅防护方案（PLP）是否能改善骨科手术住院医师的辐射暴露监测。
这是一项回顾性病例对照研究，对15名骨科手术住院医师在2年期间（2017年3月至2019年2月）的辐射暴露情况进行监测。在第一个12个月期间（阶段1），每月给住院医师发放辐射剂量计徽章，并指示他们每天将其佩戴在挂在手术室外面的公用铅围裙上。在第二个12个月期间（阶段2），实施了个性化铅防护方案（PLP组），为住院医师提供绣有他们个人名字的铅围裙。指定一名辐射安全官员，每月将徽章佩戴在所有铅围裙上，并在月底收回徽章，而教员则确保住院医师佩戴他们的个性化铅围裙。收集的数据包括研究期间所有骨科手术中的透视使用时间和辐射剂量计读数。
对照组在阶段1有1252例使用透视的骨科手术，PLP组在阶段2有1269例。所有病例的每月总透视暴露时间在阶段1平均为190分钟，在阶段2为169分钟，两组之间无显著差异（p<0.45）。在阶段1，73.1%的剂量计报告有辐射暴露，而在阶段2，88.7%的剂量计报告有辐射暴露（p<0.001）。在阶段1，住院医师剂量计的平均每月暴露读数为7.26毫雷姆（mrem）±37.07，而在阶段2为19.00 mrem±51.16，显著更高（p<0.036）。
实施个性化铅防护方案提高了骨科手术住院医师辐射剂量计徽章的依从性和暴露读数，而实际每月透视时间没有变化。教学医院应考虑实施个性化铅防护方案以更准确地监测暴露情况。
3级。
