Dose evaluation of medical staff during proximal femur fracture surgery using fluoroscopy.

Abstract

The use of fluoroscopy in orthopedic interventional procedures has become increasingly common. Although it offers significant clinical advantages by reducing procedural invasiveness, it also exposes both patients and medical staff to ionizing radiation. This study reports occupational dose measurements for surgeons during 40 proximal femur fracture procedures conducted at a reference hospital in Recife, Brazil. The estimated annual effective doses for the leading and auxiliary surgeons were approximately 1.3-1.5 mSv, corresponding to about 7.5% of the annual dose limit (n= 325 procedures yr-1). The estimated annual eye lens exposures for both surgeons ranged from 4.7-5.8 mSv yr-1, approaching 30% the current eye lens dose limit. For these procedures, the glabella (forehead) position was identified as the most appropriate location for the eye lens dosimeter. A correlation betweenHp(10) values measured externally on the thyroid shield andHp(3) doses at the glabella suggests that eye lens dose measurements can serve as a preliminary indicator-within ±15%-for determining the need for dedicated eye lens monitoring when annual lens doses may exceed 15 mSv. Dose measurements to the hands varied according to the procedure type and the equipment used. The highest values were observed during complex surgeries, such as complex subtrochanteric fractures with multiple fragments. The frequency of outliers in the hand dose data, observed in approximately 15% of the procedures, is associated with cases in which at least one of the surgeon's hands was exposed to the primary beam. For the leading surgeon, the doses from outliers to the left hand accounted for 58% of the total dose to that hand, whereas for the auxiliary surgeon, 16% of procedures classified as high outliers contributed 75% of the total dose. These findings emphasise the importance of keeping hands outside the primary beam, as even brief direct exposures can significantly increase occupational hand doses.