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IPOTI Radiasi

Radiasi

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Neokaomi Nobroy
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91 views42 pages

IPOTI Radiasi

Radiasi

Uploaded by

Neokaomi Nobroy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ORTHOPAEDIC RADIATION IN

OPERATING THEATRE

Ghuna Arioharjo Utoyo, dr., SpOT(K)

Basic Orthopaedic Nurse Education (BONE)


Learning outcomes
• Describe effect of radiation on human organs and cells

• Outline how the radiation exposure will affect the


operation room personnel

• List the various factors for minimizing radiation hazards


during intraoperative imaging

• Describe how to use the C-arm to minimize radiation


hazards and provide optimal intraoperative imaging

2
Why discuss radiation hazards?

• A number of orthopedic surgeons have


been diagnosed with tumors during their
working life
• Some do not take enough care while using
x-rays in the OR
Physical facts

• Normal exposure

• Cosmic rays in high-altitude flights: 0.001–0.01 mSv/hour


• Natural background radiation: 0.01 mSv/day
Physical facts

Medical exposure
Chest x-ray 0.1 mSv
CT scan, head 1.5 mSv 15 chest x-rays
CT scan, whole 9.9 mSv 100 chest x-rays
body
Physical facts

• Radiation from a nuclear bomb: 500–1000 mSv

50–100 whole body CT scans!


Biological facts—ionizing radiation

Somatic effects (500–1000 mSv):


• Radiation sickness
• Leukemia
• Thyroid cancer
• Radiation cataract

Directly related to dose


Below certain threshold, no increased risk
Biological facts—ionizing radiation

Genetic effects:
• Mutagenic effects (dose related) proven in
animals

Teratogenic effects:
• At 18–85 days of gestation provoked by 10 mSv
Specific body exposure

• Hands have greatest exposure risk

• Eyes:
– Radiation cataract

• Thyroid:
– 85% of papillary carcinoma are
radiation induced
Modern orthopedic trauma surgery

• Increased exposure of surgeon, patient, and


team to radiation by minimally invasive
procedures

– Intramedullary (IM) nailing

– Percutaneous K-wire fixation

– Minimally invasive plate osteosynthesis (MIPO)

– Vertebroplasty
Physical facts—absorption and scatter

• Radiation scatter is mainly


directed toward the source

Main source of radiation


for team and surgeon is
scattered radiation from patient
Distance

Reasonably safe at
3 m away from
source!
Who receives the most exposure?

3-month period: 107 consecutive operations


• Surgeon always >90 cm from beam
• Assistant ~10 cm from beam

• Radiation dose:

Dose measurement Surgeon Assistant

Outer dosimeter 0.0375 mSv 0.21 mSv


Experience and exposure during IM nailing

22 procedures of IM nailing of long bones

• Senior group (12) versus junior group (10)

Fluorometric time statistically greater


for junior group
X-ray tube position
X-ray tube
up

✗ ✗
Intensifier
down
Tube position below OR table
reduces radiation dose to eye lens by 3 or more times
Best configuration
Intensifier up

✔ ✔
X-ray tube
down
X-ray tube position
Exception:
hand, small-part surgery
Scatter is minimal

x-ray tube up

intensifier down

Avoid direct exposure to beam


Stay away as much as possible
X-ray tube position
• Exposure at x-ray
tube side: ✗ ✔
– Thyroid X 3–4

– Torso X 25

Stay away from the x-ray tube side


during fluoroscopy
X-ray tube position
• Exposure at x-ray
tube side: ✗ ✔
– Thyroid X 3–4

– Torso X 25

Hug the intensifier!


Factors affecting staff and patient doses
Patient size increases skin dose and scattered radiation

• Use additional protective devices


• Keep a safe distance from large patients
Factors affecting patient doses
Intensifier Patient
diameter entrance dose

32 cm (12 in) Dose 100

More magnification
22 cm (9 in) Dose 150

16 cm (6 in) Dose 200

11 cm (4.5 in) Dose 300

More magnification (smaller ii diameter)


increases patient entrance dose
Factors affecting patient doses
Intensifier
diameter
✗ Patient
entrance dose

32 cm (12 in) Dose 100

More magnification
22 cm (9 in) Dose 150

16 cm (6 in) Dose 200

11 cm (4.5 in) Dose 300

Do not use too much magnification


Factors affecting staff and patient doses

Patient dose will increase if:

✗
• Focus–skin distance is short

• Patient–image intensifier distance is


large
Factors affecting staff and patient doses

Patient dose will increase if:

• Focus–skin distance is short

• Patient–image intensifier distance is


✔
large

Reduce scatter:
Place patient close to image intensifier
Remember to protect patients
• Away from x-ray tube
• Protective shield for patients on side of x-ray
tube
– On patient if tube is above
– Under patient if tube is below
Protective gear

0.15 mm lead-equivalent goggles


provide 70% attenuation of
radiographic beam
Thyroid collar
2.5-fold further decreases
Apron
AP: decreased 16-fold
Lateral: decreased 4-fold

Protective gloves
60–64% protection at 52–58 KV
Protective gear

Apron and thyroid collar


• Treat them well to get good protection

Should be routinely checked


Monitoring Devices

• Wear as prescribed by regulatory


requirements
• Wear in a consistent location (eg,
one inside and one outside the
apron)
• Finger dosimeters
• Store in a radiation free location
• Dosimeter reports

Copyright © 2015 AORN, Inc. All rights reserved. Used or adapted with permission.
28
Technical contributions to radiation dose
reduction
• Iso-centric C-arms:
– Repositioning not needed
Technical contributions to radiation dose
reduction
• Iso-centric C-arms:

– Repositioning not needed

• Good quality off-center imaging

– No need to repeat exposure

• Remove/reduce metals in the field

– C-arms automatically increase


exposure to improve bone
image
Clinical C-arm application: “C-arm attitude”

• Landmarks (floor)
Clinical C-arm application: “C-arm attitude”

• Landmarks (floor, body)


Clinical C-arm application: “C-arm attitude”

• Landmarks (floor, body)


• Laser aiming
Clinical C-arm application: “C-arm attitude”

• Landmarks (floor, body)


• Laser aiming
• Pulsed acquisition

1 second of fluoroscopy =
15–25 frames of
pulsed acquisition!

Best by a technician!
Clinical C-arm application: “C-arm attitude”

• Landmarks (floor,
body)
• Laser aiming
• Pulsed acquisition
• Distance
Clinical C-arm application: “C-arm attitude”

• Landmarks (floor, body)


• Laser aiming
• Pulsed acquisition
• Distance
• Position of x-ray tube
Clinical C-arm application: “C-arm attitude”

• Landmarks (floor, body)


• Laser aiming
• Pulsed acquisition
• Distance
• Position of x-ray tube
Clinical C-arm application: “C-arm attitude”

• Landmarks (floor, body)


• Laser
• Pulsed acquisition
• Distance
• Position of x-ray tube
• Protective gear
Clinical C-arm application: “C-arm attitude”

• Landmarks (floor, body)


• Laser
• Pulsed acquisition
• Distance
• Position of x-ray tube
• Protective gear
• Keep hands away from the beam
• Shout when exposing and
scream “Screening!”
•
Summary

We have an obligation towards the safety of:


• Our patients
• Our staff
• Ourselves
Take-home messages

• Scattered radiation to be avoided


• Keep x-ray tube:
 Underneath the patient,
 Away from patient
 Away from you (lateral view)
• Use pulsed acquisition
• Land marks on the floor/body, use laser aiming
• Use protective gear routinely
• Keep your hands out of the beam
• Shout out when screening
Take-home messages

Hug the Intensifier !

Thank You

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