title: Dosimetry during intramedullary nailing of the tibia.
abstract: BACKGROUND
  Intramedullary nailing under fluoroscopic guidance is a common operation. We studied the intraoperative radiation dose received by both the patient and the personnel.
  
  
  METHODS
  25 intramedullary nailing procedures of the tibia were studied. All patients suffered from tibial fractures and were treated using the Grosse-Kempf intramedullary nail, with free-hand technique for fixation of the distal screws, under fluoroscopic guidance. The exposure, at selected positions, was recorded using an ion chamber, while the dose area product (DAP) was measured with a DAP meter, attached to the tube head. Thermoluminescent dosimeters (TLDs) were used to derive the occupational dose to the personnel, and also to monitor the surface dose on the gonads of some of the patients.
  
  
  RESULTS
  The mean operation time was 101 (48-240) min, with a mean fluoroscopic time of 72 seconds and a mean DAP value of 75 cGy x cm(2). The surface dose to the gonads of the patients was less than 8.8 mGy during any procedure, and thus cannot be considered to be a contraindication for the use of this technique. Occupational dose differed substantially between members of the operating personnel, the maximum dose recorded being to the operator of the fluoroscopic equipment (0.11 mSv).
  
  
  CONCLUSIONS
  Our findings underscore the care required by the primary operator not to exceed the dose constraint of 10 mSv per year. The rest of the operating personnel, although they do not receive very high doses, should focus on the dose optimization of the technique.
authors.affiliation: Department of Orthopaedics, School of Medicine, University of Patras, Patras, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Kirousis
authors.forename: Harry
authors.initials: H
authors.lastname: Delis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Megas
authors.forename: Elias
authors.initials: E
authors.lastname: Lambiris
authors.forename: George
authors.initials: G
authors.lastname: Panayiotakis
mesh_terms: D001858:Bone Nails; D005471:Fluoroscopy / Q000009:adverse effects*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D006066:Gonads / Q000528:radiation effects; D006801:Humans; D016273:Occupational Exposure / Q000009:adverse effects; D011829:Radiation Dosage; D013819:Thermoluminescent Dosimetry; D013977:Tibia / Q000528:radiation effects / Q000601:surgery; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*