title: Radiation exposure to the orthopaedic surgical team during fluoroscopy: "how far away is far enough?".
abstract: OBJECTIVE
  To correlate the amount of radiation exposure to members of the orthopaedic surgical team based on their relative positions during a simulated fluoroscopically assisted orthopaedic procedure.
  
  
  METHODS
  Experimental study using commercially available fluoroscopic units and dosimetry badges designed to measure "eye" (ocular lens), "shallow" (hands/skin), and "deep" (whole-body) radiation exposure.
  
  
  METHODS
  Standard hospital operating room at a level one trauma center.
  
  
  METHODS
  Dosimetry badge clusters at specified distances from a fluoroscopic x-ray beam. Represented positions were direct beam contact, surgeon (12 in/30.5 cm), first assistant (24 in/70 cm), scrub nurse (36 in/91.4 cm), and anesthesiologist (60 in/152.4 cm).
  
  
  METHODS
  Dosimetry badges were systematically exposed by a protocol intended to maximize radiation scatter. A maximum time for continuous fluoroscope use was set at ten minutes.
  
  
  METHODS
  Radiation exposure readings from dosimetry badges processed by a commercially available dosimetry service.
  
  
  RESULTS
  Maximum readings are reported. Direct beam contact resulted in approximately 4000 mrem/minute (40 mSv/min) of radiation exposure. Deep exposure for the surgeon and first assistant was 20 mrem/min (0.2 mSv/min) and 6 mrem/min (0.06 mSv/min), respectively. Superficial exposure was 29 mrem/min (0.29 mSv/min) for the surgeon and 10 mrem/min (0.1 mSv/min) for the first assistant. Eye exposure was 10 mrem/min (0.1 mSv/min) for the surgeon and 6 mrem/min (0.06 mSv/min) for the first assistant. At the scrub nurse position, no deep or eye exposure was detected. One positive badge for shallow exposure was noted at the scrub nurse position, reflecting a 2 mrem/min (0.02 mSv/min) exposure rate. After ten minutes of continuous exposure, badges assigned to the anesthesiologist position never registered any positive readings.
  
  
  CONCLUSIONS
  These results indicate that unprotected individuals working twenty-four inches (70 cm) or less from a fluoroscopic beam receive significant amounts of radiation, whereas those working thirty-six inches (91.4 cm) or greater from the beam receive an extremely low amount of radiation.
authors.affiliation: University of Cincinnati College of Medicine, Children's Hospital Medical Center, OH, USA.
authors.forename: C T
authors.initials: CT
authors.lastname: Mehlman
authors.forename: T G
authors.initials: TG
authors.lastname: DiPasquale
mesh_terms: D000398:Air Pollution, Radioactive / Q000032:analysis*; D005373:Film Dosimetry; D005471:Fluoroscopy / Q000009:adverse effects*; D006801:Humans; D016273:Occupational Exposure / Q000517:prevention & control*; D009873:Operating Rooms; D019637:Orthopedic Procedures; D009985:Orthopedics; D010348:Patient Care Team; D010564:Personnel, Hospital; D011829:Radiation Dosage; D018570:Risk Assessment; D013997:Time Factors; D000078329:Workforce