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Trauma surgery and risk of radiation injury to patients

  • Sabur MalekEmail author
  • Eirian Davies
  • Ibrahim A. Malek
  • Arvind Rawal
  • Alok Singh
  • Robert A. Harvey
Original Article

Abstract

Image intensifiers are widely used in orthopaedic trauma surgery. Since beginning of fluoroscopy use, concerns have been raised regarding the radiation risks to the patients and the theatre staff in these operations. The radiation risks are classified into two types, stochastic and deterministic risks. Effective dose (ED) and skin dose (SD) values were derived from dose area product (DAP) values and used to quantify the stochastic and deterministic risks, respectively. Patients (670) who had dynamic hip screw (DHS) fixation, cannulated hip screw (CHS) fixation, intra-medullary nailing (IMN) of femur and tibia were included in the study. ED values were 0.3, 0.6, 0.9 and 0.01 mSv and stochastic risks were 3 × 10−5, 6 × 10−5, 9 × 10−5 and 1 × 10−6 for DHS, CHS, IMN of femur and IMN of tibia, respectively. Maximum SD values were 36, 65, 100 and 46 mGy which were only 2, 3, 5 and 2% of threshold dose for temporary skin erythema (2 Gy) in DHS, CHS, IMN of femur and IMN of tibia operations. The radiation exposure in these operations was very low compared to common intervention radiology procedures. The study concludes that the risk of radiation injury in lower limb trauma surgery is extremely small. The radiation doses to patients are within maximum permissible dose (MPD) limits recommended by International Commission on Radiological Protection.

Keywords

Radiation Effective dose Skin dose Fracture neck of femur Intra-medullary nailing 

Chirurgie traumatologique et risque d’irradiation des patients

Résumé

Les amplificateurs de brillance sont largement utilisés en chirurgie traumatologique de l’appareil locomoteur. Depuis le début de l’utilisation de la fluoroscopie, le risque d’irradiation des patients et du personnel de bloc opératoire ont fait l’objet de la plus grande attention. Les risques d’irradiation sont classés en deux types, stochastiques et déterministes. Les valeurs des doses efficaces (ED) et cutanées (SD) ont été obtenues à partir du produit de la dose par surface (DAP) et utilisées pour évaluer quantitativement et respectivement les risques stochastiques et déterministes. 670 patients opérés par vis dynamique du fémur proximal (DHS), vis canulée du fémur proximal (CHS), enclouage centromédullaire (ECM) du fémur et du tibia ont été inclus dans l’étude. Les valeurs de ED étaient de 0.3, 0.6, 0.9 et 0.01 mSv et les risques stochastiques étaient respectivement de 3 × 10−5, 6 × 10−5, 9 × 10−5 et 1 × 10−6 pour les DHS, CHS, ECM de fémur et ACM de tibia. Les valeurs de SD maximum étaient de 36, 65, 100 et 46 mGy, ce qui correspondait à seulement 2, 3, 5 et 2% de la dose seuil de l’érythème cutané labile (2 Gy) pour les interventions de DHS, CHS, ECM du fémur et du tibia. L’irradiation dans ces opérations était très basse comparée aux protocoles habituels de radiologie conventionnelle. L’étude conclut que le risque de lésion d’irradiation dans la chirurgie des traumatismes du membre inférieur est extrêmement faible. Les doses d’irradiation délivrées aux patients sont dans la limite de la dose maximale permise (MPD) recommandée par la Commission Internationale sur la Protection Radiologique.

Mots clés

Irradiation Dose effective Dose cutanée Fracture du col du fémur Enclouage centromédullaire 

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Sabur Malek
    • 1
    • 4
    Email author
  • Eirian Davies
    • 2
  • Ibrahim A. Malek
    • 3
  • Arvind Rawal
    • 2
  • Alok Singh
    • 2
  • Robert A. Harvey
    • 2
  1. 1.University of Hull and Hull Royal InfirmaryHullUK
  2. 2.Wirral Hospital NHS TrustArrowe Park HospitalWirralUK
  3. 3.Royal Liverpool Children’s NHS TrustLiverpoolUK
  4. 4.CardiffUK

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