Jones D G, Stoddart J
Palmerston North Hospital, New Zealand.
Aust N Z J Surg. 1998 Nov;68(11):782-4. doi: 10.1111/j.1445-2197.1998.tb04676.x.
There is concern about the exposure of orthopaedic surgeons to radiation. The aim of this study was to monitor radiation use in theatre to improve practice and to attempt to quantify the radiation dose the orthopaedic surgeon may have received.
A 6-month prospective audit of all procedures performed in the orthopaedic theatre that used fluoroscopy or radiographs was undertaken An anthropomorphic phantom was used to measure scatter and direct-skin doses. Screening times were recorded in a subsequent 6-month post at a tertiary trauma centre.
Fluoroscopy or radiographs were used in 378 procedures. Fluoroscopy was used in 260 procedures with a screening time of 124 min at an average of 0.48 min per procedure. Lead aprons were worn in 99% of cases and thyroid guards in 32%. All dosimeter badges were negative. The surgeon's hand was caught in the fluoroscopy beam in 15% of procedures. The phantom recordings ranged from 13 to 210 microGy for skin dose and 0.17-0.87 microGy for scatter dose. The calculated hand exposure was less than 5% of recommended levels. In the trauma post 210 min of screening was used potentially increasing the hand exposure to one-third of recommended limits. If a printer was used to record the image, 58% of intra-operative radiographs would have been avoided.
Hand exposure to radiation is the limiting factor in orthopaedics. The extremity limit will only be exceeded if the hands are regularly caught in the beam. Dose-reduction gloves should be considered for high-risk procedures. A printer can reduce the need for intraoperative plain radiographs.
骨科医生面临辐射暴露的问题令人担忧。本研究的目的是监测手术室中的辐射使用情况，以改进操作，并试图量化骨科医生可能接受的辐射剂量。
对骨科手术室中所有使用透视或X光片的手术进行了为期6个月的前瞻性审计。使用拟人化体模测量散射剂量和直接皮肤剂量。在一家三级创伤中心随后的6个月内记录了筛查时间。
378例手术中使用了透视或X光片。260例手术使用了透视，筛查时间为124分钟，平均每例手术0.48分钟。99%的病例佩戴了铅围裙，32%的病例佩戴了甲状腺防护装置。所有剂量计徽章读数均为阴性。15%的手术中医生的手被透视光束照射到。体模记录的皮肤剂量范围为13至210微戈瑞，散射剂量为0.17至0.87微戈瑞。计算得出的手部暴露量低于推荐水平的5%。在创伤病房，使用了210分钟的筛查，这可能会使手部暴露量增加到推荐限值的三分之一。如果使用打印机记录图像，58%的术中X光片可以避免。
手部辐射暴露是骨科手术中的限制因素。只有手经常被光束照射到时，才会超过肢体剂量限值。对于高风险手术，应考虑使用降低剂量的手套。打印机可以减少术中普通X光片 的使用需求。
