title: Prospective Assessment of the Oncogenic Risk to Patients From Fluoroscopy During Trauma Surgery.
abstract: OBJECTIVE
  Concern about radiation exposure during surgery has focused on surgeon exposure. However, the patient receives exposure that is more direct and, in surgery about the pelvis and hip, internal pelvic nonskeletal organs often cannot be shielded without obscuring the region of surgical interest. The purpose of this study was to prospectively evaluate patients' radiation exposure during fracture surgery of the acetabulum, pelvic ring, and femur to calculate future cancer incidence (CI).
  
  
  METHODS
  Prospective descriptive cohort.
  
  
  METHODS
  Level-1 trauma center.
  
  
  METHODS
  One hundred eight patients with acetabulum, pelvic, or femur fractures requiring operative repair were prospectively enrolled.
  
  
  METHODS
  Dosimeters were placed in locations determined for each surgery type by a medical physicist.
  
  
  METHODS
  Demographics, operative records, and average x-ray emission energy were recorded. Effective dose, specific organ doses, and lifetime CI for a 30-year-old patient were calculated.
  
  
  RESULTS
  Diagnoses included 27 acetabular fractures, 30 intertrochanteric femur fractures, 26 femoral shafts, and 25 pelvic ring injuries. Patients with pelvic ring injuries received the highest effective dose at 0.91 ± 0.74 mSv. The average lifetime increase in CI, for any cancer type, after pelvic ring fixation is 0.0097% for females and 0.0062% for males. The greatest mean single-organ dose to the ovaries (3.82 ± 3.34 mGy) occurred during pelvic ring surgery, correlating to an increased ovarian cancer risk of 0.0013%. The greatest mean single-organ dose to the prostate (6.81 ± 5.91 mSv) also occurred during pelvic surgery, correlating to increased prostate cancer risk of 0.0024%.
  
  
  CONCLUSIONS
  Fracture surgery to the pelvis and femur is exceptionally fluoroscopy-dependent; however, the radiation exposure incurred represents a relatively small increased risk of future cancer development in patients.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; Departments of †Orthopaedics, and ‡Radiology, University of Utah Hospitals and Clinics, Salt Lake City, UT.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Beebe
authors.forename: Peter
authors.initials: P
authors.lastname: Jenkins
authors.forename: David L
authors.initials: DL
authors.lastname: Rothberg
authors.forename: Erik N
authors.initials: EN
authors.lastname: Kubiak
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Higgins
mesh_terms: D000077:Acetabulum / Q000293:injuries / Q000601:surgery; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D005264:Femoral Fractures / Q000601:surgery; D005471:Fluoroscopy / Q000009:adverse effects*; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology* / Q000517:prevention & control; D010384:Pelvic Bones / Q000293:injuries / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects* / Q000032:analysis; D011835:Radiation Protection / Q000379:methods; D018570:Risk Assessment; D012737:Sex Factors; D014193:Trauma Centers