versión On-line ISSN 2078-5151
S. Afr. j. surg. vol.50 no.2 Cape Town may. 2012
B. van der Merwe
M.Tech.; School of Health Technology, Central University of Technology, Bloemfontein
OBJECTIVES: To evaluate the effects of ionising radiation and radiation limits, and measure radiation doses received by surgeons in theatre.
DESIGN: Thermoluminescent dosimeter measurements of accumulated dose to specific anatomical regions of a neurosurgeon, gastroenterologist and orthopaedic surgeon performing fluoroscopy on 39 patients undergoing treatment for back pain, 7 for endoscopic retrograde cholangiopancreatography procedures, and 48 for orthopaedic operations respectively.
RESULTS: Radiation dose levels with the X-ray tube above the table during back pain procedures exceeded the occupational annual recommendation to the neurosurgeon's hands. The protocol regarding the orientation of the C-arm was changed. Convincing evidence of the importance and effectiveness of lead shielding was recorded.
CONCLUSIONS: Constant revision of protocols should apply the as-low-as-reasonably-achievable principle in every unique setting. The ideal is to position the image intensifier above the theatre table. The longest possible distance from the source will lower radiation risk. Full-body protection of 0.35 mm lead equivalence during fluoroscopy is mandatory.
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1. Wilks R. Principles of Radiological Physics. Edinburgh: Churchill Livingstone, 1981:371-451. [ Links ]
2. Zhou Y, Singh N, Abdi S, Wu J, Crawford RN, Furgang FA. Fluoroscopy radiation safety for spine interventional pain procedures in university teaching hospitals. Pain Surgeon 2005;8(1):49-53. [ Links ]
3. ICRP (International Commission of Radiological Protection) 1990 Recommendations of the International Commission on Radiological Protection. New York: Elsevier, 1991;22(1-3):1-201. [ Links ]
4. Miller DL, Balter S, Wagner LK, et al. Quality improvement guidelines for recording patient radiation dose in the medical record. J Vasc Interv Radiol 2004;5:423-429. [ Links ]
5. ICRP (International Commission of Radiological Protection) Annals of the ICRP. Avoidance of radiation injuries from medical interventional procedures. ICRP Publication 85 2000; 30 (2):1-67. New York: Elsevier. [ Links ]
6. Task Group VI of the Radiation Protection Committee. Managing the Use of Fluoroscopy in Medical Institutions. Report No. AAPM 58. Madison, WI: Medical Physics Publishing on behalf of the American Association of Physicists in Medicine. [ Links ]
7. Bushberg JI, Seibert JA, Leidholdt EM, Boone JM. The Essential Physics of Medical Imaging. 2nd ed. Hagerstown, MD: Lippincott & Wilkins, 2001:737-860. [ Links ]
8. Health Physics Society. Protection of Radiation Workers and the Public. Part 2:1-8. http://www.umich.edu/~radinfo/introduction/risk.htm (accessed 13 August 2006). [ Links ]
10. Hazardous Substances Act, 1973 (Act No. 15 of 1973). Regulations Relating to Group IV Hazardous Substances. No. R247. No 14596. Pretoria: Government Printer, 26 February 1993. [ Links ]
11. Fishman SM, Smith H, Meleger A, Seibert JA. Radiation safety in pain medicine. Reg Anesth Pain Med 2002;27(3):296-305. [ Links ]
12. Radiation Safety Office. Henry Ford Health System. 2001. (a) [online] 1-11. [ Links ] RSO Fluoroscopy Training - Fluoro Training On Line. Chapter 1. Radiation Physics. http://www.radiologyresearch.org/radiationsafety/rso_fluoroscopy_training_online.htm (accessed 18 April 2005).