Radiation hazards in operation theatre: Anaesthesiologist's concerns and preventive strategies.

Abstract

Sir, The use of X-ray fluoroscopy has led to remarkable advancements in management of various disorders. However, operation theatre staff are repeatedly exposed to radiation, which can cause bone marrow suppression, genetic mutations and carcinogenesis, etc. The aim of this letter is to draw the attention of senior authorities to the fact that guidelines should be prepared and followed strictly to monitor radiation exposure to anaesthesiologists. Knowledge of various physical and biochemical aspects of radiation is important to prevent potential hazardous consequences of its exposure.[1] In a study comparing the effect of the use of single or two C-arms, duplicate thermoluminescent dosimeter (TLD) badges were placed on surgeons’ and scrub technicians’ eyewear, thyroid shields, and waist. It was concluded that the use of lead aprons and thyroid shields reduced radiation exposure by 50%.[2] The National Council on Radiation Protection was established in United States (US) to help set US policy on radiation protection.[3] Various prophylactic measures include increased filtration and use of higher tube voltage or lower tube current. Pulsed fluoroscopic operation should be set at rate of 4 pulses/s and C-arm should be positioned underneath the table. Recommended distance to avoid exposure is approximately 3 feet from the source.[4] The use of biplanar fluoroscopy reduces both radiation exposure and surgical time. Lead aprons should be regularly checked for any breakage by an assigned technician. Mobile full body lead shield can be used, as it can both effectively shield off scattered radiation and do not add extra weight. During repeated and long procedures, patients should also be protected with lead shield. Educational programs should be conducted for awareness of radiation hazards and safety measures among operation theatre personnel. Staff should be taught to avoid close contact with tilted side of fluoroscope as scattered radiation increases when emission tube gets tilted.[5] Certain adjustments in fluoroscopy machine such as avoiding any metal parts within fluoroscopy field, by closing iris and adjusting size of collimator, the amount of radiation generated can be reduced.[5] Lead acrylic glasses can be used to avoid damage to lens. Lead impregnated gloves can be used in high-risk procedures. Both ionising and non-ionising radiations pose potential hazards to anaesthesiologists. If recommended dose limit exceeds 15 mSv/year, cumulative effects of radiation can affect whole body or can result in localised effects such as cataract. Anaesthesiologists posted in OTs where fluoroscopy is used routinely should have two badges including one for cumulative and another for individual exposure. These badges should be made available from the reputed suppliers. Their use establishes the dose received and verifies the adequacies of facilities for radiation protection. As part of safety, according to Atomic Energy (Radiation Protection) Rules 2004 section (3), a licence/registration is necessary for establishing the radiation installation. This procedure involves three steps: The director, directorate of radiation safety (DRS) first approves the site where equipment has to be installed Then quality assurance test is done by the manufacturer or supplier under intimation to DRS After that licence/registration is issued by Atomic Energy Regulatory Board (AERB) through DRS. Recommendations from AERB to improve quality of care include: It is the responsibility of the employer to provide radiation-monitoring devices (TLD badges) to radiation workers X-ray installations should be located as far as possible from areas of high occupancy such as maternity, paediatric and ultrasonography rooms Quality assurance should be conducted once in 2 years on every X-ray equipment and records to be maintained by registrant/licensee. Thus by taking various prophylactic measures, safety of the anaesthesiologists can be enhanced.