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Learning outcomes
Describe the physical and biological facts of radiation. Demonstrate an understanding of how and when to use x-rays during orthopaedic trauma procedures. Protect patients, teams and surgeons from radiation during surgery.
Outline
Physical facts Biological facts How to protect team and surgeon C-arm and x-ray tube position Protective clothing Efficient use of radiation Planning Positioning "C-arm attitude"
Physical facts
Radiation is energy from electromagnetic waves X-radiation = ionizing radiation Wavelength: 150.01 nanometer (nm) Frequency: 2.5x10176x1019 Hz Energy: 1 eV250 keV
Units of measurement Rem: energy delivered by x-radiation Gray (1 Gy = 1 Joule/kg): energy deposited in material, reflects physical effect Sievert (1 Sv = 1 Joule/kg): dose equivalent, reflects the biological effect
Physical facts
Units 100 rem = 1 Gy = 1 Sv 100 milirem = 1 mGy = 1 mSv (=1000 Sv) Normal exposure Cosmic ray in high-altitude flights: 0.0010.01 mSv/hour Natural background radiation: 0.01 mSv/day In USA: natural cosmic radiation is 0.27 mSv/year
Physical facts
Medical exposure Chest x-ray: CT scan head: CT whole body: Cardiac CT angio:
Physical facts
Accidental exposure Radiation sickness: 5001000 mSv Radiation from nuclear bomb: 5001000 mSv
Biological facts
85% of papillary carcinomas = radiation induced
Vertebroplasty
MIPO
Intramedullary nail
1.1 Sv 1.1 Sv
19.0 Sv 35.4 Sv
49.8 Sv 55.5 Sv
3.1 Sv
41.7 Sv
117.0 Sv
Protection measures
Physical facts
Absorption and scatter: For every 1000 photons reaching the patient ~100200 are scattered ~ 20 reach the image detector rest are absorbed (= radiation dose) by the patient In radiology, radiation scatter is mainly directed toward the source
The main source of radiation for the team and surgeon during fluroscopy is scattered radiation from the patient
Scatter-dose rate is lower when distance between patient and surgeon increases
Under-gown dosimeter:
Surgeon
Assistant
0.0 mSv
0.05 mSv
22 procedures of IM nailing of long bones Senior group (12) vs junior group (10)
intensifier up
Staff should stay clear of the x-ray tube area during fluoroscopy
Use additional protective devices or keep a safe distance from large size patients
32 cm (12 in)
Dose 100
Dose 150
Dose 200
Dose 300
Reduce scatter: place patient close to image intensifier and far from x-ray tube
dose
Laser
Pulsed acquisition Distance Position of x-ray tube Protection
Summary
Radiation hazard can be reduced by: C-arm orientation Positioning x-ray tube underneath the patient Lateral view: stay away from x-ray tube Keep x-ray tube at maximal distance to the patient Keep image intensifier close to the patient Do not overuse magnification Considering scatter radiation Wearing protective clothing Keeping distance Keeping your hands out of the beam!