Thibault Jeremie, Naciri Walid, Rouleau Dominique M, Chapleau Julien
From the Faculty of Medicine, Université de Montréal, Montréal, Que. (Thibault, Naciri, Rouleau, Chapleau); the Department of Orthopedic Surgery, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Que. (Rouleau, Chapleau).
Can J Surg. 2025 Jun 10;68(3):E235-E241. doi: 10.1503/cjs.003824. Print 2025 May-Jun.
Although fluoroscopy is used routinely, surgeons and orthopedic residents are inadequately educated about the dangers associated with radiation exposure and protective measures in the operating room. We sought to report the average radiation exposure during common orthopedic trauma procedures for different team members and to determine if the fluoroscopy emitting report is correlated with the radiation measured in the room.
We conducted a prospective observational study over 3 months in a level 1 trauma centre. We collected radiation levels from dosimeters in different standardized locations at 1 m, 2 m, and 3 m from the C-arm machine, labelled as dosimeters A, B, and C, corresponding to the locations of the surgeon, anesthesiologist, and nurse, respectively). We classified mean exposure (and standard deviations [SDs] according to the body part exposed and the dose delivered.
We included recordings from 100 patients who underwent surgery for fractures, of which 50 involved a distal extremity, 31 involved a proximal extremity and 19 involved the pelvic area. Dosimeter A (surgeon) recorded a significantly higher amount of radiation at a mean of 20.35 (SD 54.25) μSv than the other 2 dosimeters (B [anesthesiologist]: 0.87 [SD 1.55] μSv; C [nurse]: 0.49 [SD 0.92] μSv), regardless of the fracture location. Higher radiation levels were recorded for fixation of centrally located fractures, followed by lower-extremity fractures and upper-extremity fractures. Half-dose and quarter-dose fluoroscopy emitted statistically lower radiation than standard-dose fluoroscopy. The radiation report from the fluoroscopy machine was highly correlated with the measured radiation (ρ = 0.93; = 0.909, < 0.001).
Radiation exposure is much higher closer to the fluoroscopy machine and decreases following an inverse-square law from the radiation source, becoming negligible at 2 m from the source. Using the low-dose radiation mode can significantly decrease radiation exposure.
尽管荧光透视在手术中被常规使用，但外科医生和骨科住院医师对于手术室中与辐射暴露相关的危险及防护措施的了解并不充分。我们试图报告不同团队成员在常见骨科创伤手术过程中的平均辐射暴露情况，并确定荧光透视发射报告是否与手术室中测量到的辐射相关。
我们在一家一级创伤中心进行了为期3个月的前瞻性观察研究。我们从距离C形臂X线机1米、2米和3米的不同标准化位置的剂量仪收集辐射水平，分别标记为剂量仪A、B和C，对应外科医生、麻醉师和护士的位置。我们根据暴露的身体部位和传递的剂量对平均暴露量（及标准差[SD]）进行分类。
我们纳入了100例接受骨折手术患者的记录，其中50例涉及远端肢体，31例涉及近端肢体，19例涉及骨盆区域。剂量仪A（外科医生）记录的平均辐射量显著高于其他两个剂量仪（B[麻醉师]：0.87[SD 1.55]μSv；C[护士]：0.49[SD 0.92]μSv），为20.35（SD 54.25）μSv，无论骨折位置如何。中央部位骨折固定的辐射水平较高，其次是下肢骨折和上肢骨折。半剂量和四分之一剂量的荧光透视发射的辐射在统计学上低于标准剂量的荧光透视。荧光透视机的辐射报告与测量到的辐射高度相关（ρ = 0.93； = 0.909， < 0.001）。
靠近荧光透视机时辐射暴露要高得多，并且从辐射源开始遵循平方反比定律下降，在距离源2米处可忽略不计。使用低剂量辐射模式可显著降低辐射暴露。
