Dose area product measurement in orthopaedic trauma: An attempt at establishing a local diagnostic reference level

Abstract

Background The Ionizing Radiations Medical Exposure Regulations Act IR(ME)R2000, requires the establishment of diagnostic reference levels (DRL) for radiological examinations. Current National Radiation Protection Board guidelines do not have any dose data available on orthopaedic trauma. Where National guidelines are not available, the establishment of local DRLs, to collect dose data and to set intervention levels is important. Materials and methods Dose area product measurement in 1000 patients who underwent emergency trauma surgery was analyzed. This included 210 hip fractures, 315 wrist fractures, 117 ankle fixations, 94 supracondylar fractures, 47 intramedullary nailing, 24 joint relocations, and 139 other examinations of extremities. The median dose area product (DAP) along with the first and third quartile values for each procedure was calculated. Results Intramedullary nailing of femur was done at the highest exposure with the median DAP of 68.5 cGy cm 2, followed by hip pinning. Values for fracture neck of femur exceeded those of tibial nailing. Among close reduction tibia and fibula manipulation had the highest radiation values between first and third quartiles of the distribution to give a possible DRL range and this has been determined. Discussion The DRL is a measure of patient dose and serves as a quantitative guide to optimization of radiological protection. The IR(ME)R states that if the DRL for an examination is exceeded by a particular piece of equipment or operator, legislation requires that reasons be investigated and remedial action be taken. It is hoped the study will contribute to the establishment of a national DRL for orthopaedic examinations.