02 Jul Peri-Operative Staff & X-ray
Health care workers are exposed to a number of hazards within the operating room. X-rays are commonly undertaken intra-operatively to assess & identify fractures, bone alignment and blockages in organs & vessels. A number of surgical specialties routinely utilise intra-operative imaging.
One of the hazards of x-rays is the radiation that is expelled from the C-arm & O-arm of the mobile Intensive Imaging (II) device.
Health care workers are aware of these issues and as a result utilise safety precautions, which include, wearing a wrap- around knee length, lead gown or apron & vest, of between 0.25mm to 0.5mm, in addition to wearing a thyroid protector and safety lead glasses. An excessive amount of ionising radiation exposure has been linked to biological cell damage that can lead to cancer and cataracts.
The amount of radiation exposure varies depending upon the surgical procedure and the type of X-ray. Fluoroscopy exhibits the highest amount of radiation and is used primarily in urological cases, endo-luminal cardiac and vascular cases and ERCP cases. Fluoroscopy uses contrast whilst x-raying a patient to detect and identify variances in vessels and organs.
Monitoring the safety of healthcare workers is paramount. Radiation dose limits are set by the International Commission on Radiologic Protection (ICRP) and according to the (IAEA) International Atomic Energy Agency the safe annual dose range is 20mSv (effective dose range). Surgeons are particularly susceptible to increased cancer risks due to the proximity of the beam emitting radiation and the proximity to the surgeon. Best practice is for staff to stand on the opposite side of the radiating beam, have lead protection or stand at least 1.5metres or 5ft from the II beam.
Staff may also utilise a protective mobile screen and stand at least 1.5metres or 5ft from the C-arm or beam. A study found anaesthetists who were at least 5ft from an II beam had not been affected by radiation exposure, or had minimal doses detected. https://onlinelibrary.wiley.com/doi/full/10.1111/anae.13400
It is important for each staff member exposed to carry a monitoring device (dosimeter) supplied by the healthcare facility that identifies the amount of radiation each staff member has been exposed to.
All healthcare facilities should be testing the integrity of lead aprons, gowns and thyroid protectors, every 12-18mths.
Patients should be protected when possible by covering radio-sensitive organs, such as breast tissue, thyroid, eyes and gonads with lead, when applicable.
A number of Healthcare facilities have adopted the ALARA risk assessment, (as low as reasonably achievable) to aid in protecting patient and staff safety.