Radiation exposure to equine surgeons during simulated digital radiography and fluoroscopy‐guided fracture fixation of the distal limb
Julia L. Gaida, Susanne M. Stieger‐Vanegas, Christoph J. Lischer, Katja F. Duesterdieck‐Zellmer, Michael J. Huber, J. Lacy KammAbstract
Objective
Despite known occupational radiation risks, data on exposure during digital radiography (DR) or fluoroscopy‐guided equine fracture repair are lacking. This study quantified radiation doses to a model surgeon's hand, lenses, thyroid, and gonads, and assessed protective effects of radiation‐reducing surgical gloves and attenuating ointment.
Study design
Comparative, controlled, simulation‐based study.
Animal/sample population
Anthropomorphic model.
Methods
Distal limb fracture fixation was simulated using a model with dosimeters at the region of the lenses, thyroid, gonads, drill‐holding hand, and under a lead apron (fetal dose). Radiation was measured over 10 DR or 10 single‐image fluoroscopy exposures, then repeated using radiation‐reducing surgical gloves or ointment.
Results
All radiation doses were below occupational limits. Dosimeters placed at the level of the gonads (outside the gown) received the highest mean dose (DR: 6.87 ± 0.40 μSv; fluoroscopy: 0.98 ± 0.28 μSv), followed by thyroid (outside the gown) (DR: 2.60 ± 0.52 μSv; fluoroscopy: 0.48 ± 0.08 μSv), hand (DR: 2.02 ± 0.54 μSv; fluoroscopy: 0.32 ± 0.06 μSv) and lenses (DR: 1.25 ± 0.28 μSv; fluoroscopy: 0.23 ± 0.07 μSv). The lowest exposure was measured underneath the gown (fetal dose) (DR: 0.01 ± 0.01 μSv; fluoroscopy: 0.01 ± 0.01 μSv). DR exposure exceeded fluoroscopy at all sites ( p < .001). Radiation‐reducing surgical gloves significantly lowered hand dose ( p < .001), whereas ointment had no effect ( p = .54). Off‐beam hand exposure from 10 images was approximately one‐millionth of the annual dose limit.
Conclusion
Image‐guided equine distal limb fracture fixation results in minimal hand radiation exposure, relative to other regions of the body, with DR producing higher doses than single‐image fluoroscopy. Radiation‐reducing surgical gloves significantly lower hand exposure during DR procedures.
Clinical significance
Radiation‐reducing surgical gloves offer additional protection and are recommended during image‐guided surgery. Whenever feasible, pulsed fluoroscopy should be preferred over DR.