Radiation Exposure Issues in Orthopaedics*

Abstract

The topic of radiation exposure for patients, physicians, and staff has become prominent in the lay press. It seems that every week another story about radiation safety makes the evening news. For physicians and surgeons, the largest radiation exposures involve fluoroscopy use with either fixed or mobile units. For patients, fluoroscopy (c-arm), computed tomography (CT), and nuclear medicine studies constitute the vast majority of exposures. The use of each of these modalities has grown dramatically with changes in the practice of medicine. C-arm use in orthopaedic surgery is increasing rapidly as surgery transitions to minimal-access surgery. With less direct visualization, surgery is being conducted with fluoroscopic guidance. When fluoroscopy is combined with a computer for navigation systems, radiation exposure sustained by surgeons can be reduced dramatically. This transition does not decrease the patient's radiation dose, and in some instances it can increase it substantially1. CT scans have become accepted as commonplace. The rate of CT use is thirty times greater than it was twenty years ago, and the radiation exposure sustained by a patient can be dramatic2,3. Less than one-sixth of physicians receive any training in radiation safety4. One questionnaire study of physicians showed that 4% did not know that ultrasound did not involve ionizing radiation and 27% did not know that magnetic resonance imaging (MRI) did not involve radiation at all5. Approximately 90% of physicians underestimated the radiation exposure and risks from pediatric radiographs and CT scans4. A single pediatric abdominal CT scan exposes the patient to more radiation than the seventy-year exposure from living in the vicinity of the Chernobyl accident2. For a five-year-old patient who weighs 19 kg, a chest CT is the equivalent of 600 chest radiographs and a CT of the …