Radiation Exposure in Orthopaedics in Argentina
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Published:
Feb 24, 2025
Keywords:
Ionizing radiation, exposure, radiation protection, fluoroscopy, orthopaedic surgery, occupational hazard
Main Article Content
Abstract
Introduction: Many orthopedic surgical procedures require the use of fluoroscopic imaging, exposing surgeons to ionizing radiation. This study aims to assess the practices, frequency of intraoperative imaging use, level of knowledge, and adherence to radiological protection measures among orthopedic surgeons in Argentina.
Materials and Methods: This was an analytical, observational, cross-sectional study based on an online survey conducted among orthopedic surgeons in Argentina between September 2020 and October 2021. The survey included 18 questions collecting sociodemographic, professional, and occupational data related to the use of intraoperative fluoroscopy, radiation protection measures, and knowledge of radiation exposure risks.
Results: A total of 919 responses were collected. Nearly half of the participants (48.7%) reported using fluoroscopy more than once per week. However, 73.9% were unaware of their actual exposure time, 60.5% did not know whether protective equipment was regularly replaced, and only 10% reported using a dosimeter. The most commonly used protective device was the lead apron, yet only one-third of respondents used thyroid protection. Training in ionizing radiation was deemed insufficient, with 97% of respondents expressing interest in receiving formal education on the topic.
Conclusions: There is a need to raise awareness among orthopedic surgeons regarding radiation exposure. Most surgical procedures lack adequate radiological protection, and there are no mandatory training programs, standardized protocols, or monitoring systems in place.
Materials and Methods: This was an analytical, observational, cross-sectional study based on an online survey conducted among orthopedic surgeons in Argentina between September 2020 and October 2021. The survey included 18 questions collecting sociodemographic, professional, and occupational data related to the use of intraoperative fluoroscopy, radiation protection measures, and knowledge of radiation exposure risks.
Results: A total of 919 responses were collected. Nearly half of the participants (48.7%) reported using fluoroscopy more than once per week. However, 73.9% were unaware of their actual exposure time, 60.5% did not know whether protective equipment was regularly replaced, and only 10% reported using a dosimeter. The most commonly used protective device was the lead apron, yet only one-third of respondents used thyroid protection. Training in ionizing radiation was deemed insufficient, with 97% of respondents expressing interest in receiving formal education on the topic.
Conclusions: There is a need to raise awareness among orthopedic surgeons regarding radiation exposure. Most surgical procedures lack adequate radiological protection, and there are no mandatory training programs, standardized protocols, or monitoring systems in place.
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How to Cite
Cubecino, A., Garabano, G., Gamarra, D., Simesen de Bielke, H., Sierto, M. N., & Robador, N. A. (2025). Radiation Exposure in Orthopaedics in Argentina. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(1), 51-62. https://doi.org/10.15417/issn.1852-7434.2025.90.1.2036
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Basic Research
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References
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Acad Orthop Surg 2018;26(8):268-77. https://doi.org/10.5435/JAAOS-D-16-00342
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Bone Joint Surg Am 2011;93(12):e69(1-10). https://doi.org/10.2106/JBJS.J.01328
4. Ojodu I, Ogunsemoyin A, Hopp S, Pohlemann T, Ige O, Akinola O. C-arm fluoroscopy in orthopaedic surgical
practice. Eur J Orthop Surg Traumatol 2018;28(8):1563-8. https://doi.org/10.1007/s00590-018-2234-7
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Ann ICRP 2007;37(2-4):1-332. Disponible en: https://www.nrc.gov/docs/ML1233/ML12338A682.pdf
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8. Baumgartner R, Libuit K, Ren D, Bakr O, Singh N, Kandemir U, et al. Reduction of radiation exposure from C-arm fluoroscopy during orthopaedic trauma operations with introduction of real-time dosimetry. J Orthop Trauma 2016;30(2):e53-8. https://doi.org/10.1097/BOT.0000000000000442
9. Mastrangelo G, Fedeli U, Fadda E, Giovanazzi A, Scoizzato L, Saia B. Increased cancer risk among surgeons in an orthopaedic hospital. Occup Med (Lond) 2005;55(6):498-500. https://doi.org/10.1093/occmed/kqi048
10. Chou LB, Chandran S, Harris AH, Tung J, Butler LM. Increased breast cancer prevalence among female orthopedic surgeons. J Womens Health (Larchmt) 2012;21(6):683-9. https://doi.org/10.1089/jwh.2011.3342
11. Chou LB, Johnson B, Shapiro LM, Pun S, Cannada LK, Chen AF, et al. Increased prevalence of breast and all-cause cancer in female orthopaedic surgeons. J Am Acad Orthop Surg Glob Res Rev 2022;6(5):e22.00031.
https://doi.org/10.5435/JAAOSGlobal-D-22-00031
12. Vanoli F, Gentile L, Iglesias SL, Lobos Centeno E, Diaz MP, Allende Nores CA. Exposición a la radiación de los
cirujanos en la fijación interna de fracturas de radio distal. Rev Asoc Argent Ortop Traumatol 2017;82(4):271-7.
https://doi.org/10.15417/674
13. Bazán PL, Muscia R, Gomez Cano J, Corrales Pinto J, Borri AE, Medina M, et al. Incidencia de la exposición a los
rayos X en cirugías de columna. Rev Asoc Argent Ortop Traumatol 2019;84(3):208-15. https:/doi.org/10.15417/issn.1852-7434.2019.84.3.884
14. Vivas M, Herrera H, Guyot JP, Santini Araujo G, Dello Ruso B, Castellini J. Informe sobre la radio-exposición en
el personal quirúrgico de Ortopedia y Traumatología. Principios, marco legal y análisis situacional en la Argentina. Rev Asoc Argent Ortop Traumatol 2018;83(3):210-3. https://doi.org/10.15417/issn.1852-7434.2018.83.3.821
15. Gausden EB, Christ AB, Zeldin R, Lane JM, McCarthy MM. Tracking cumulative radiation exposure in orthopaedic surgeons and residents: what dose are we getting? J Bone Joint Surg Am 2017;99(15):1324-9.
https://doi.org/10.2106/JBJS.16.01557
16. Burns S, Thornton R, Dauer LT, Quinn B, Miodownik D, Hak DJ. Leaded eyeglasses substantially reduce radiation exposure of the surgeon’s eyes during acquisition of typical fluoroscopic views of the hip and pelvis. J Bone Joint Surg Am 2013;95(14):1307-11. https://doi.org/10.2106/JBJS.L.00893
17. Kesavachandran CN, Haamann F, Nienhaus A. Radiation exposure of eyes, thyroid gland and hands in orthopaedic staff: a systematic review. Eur J Med Res 2012;17(1):28. https://doi.org/10.1186/2047-783X-17-28
18. Meisinger QC, Stahl CM, Andre MP, Kinney TB, Newton IG. Radiation protection for the fluoroscopy operator and staff. AJR Am J Roentgenol 2016;207(4):745-54. https://doi.org/10.2214/ajr.16.16556
19. Hoffler CE, Ilyas AM. Fluoroscopic radiation exposure: are we protecting ourselves adequately? J Bone Joint Surg Am 2015;97(9):721-5. https://doi.org/10.2106/JBJS.N.00839
20. Al Mohammad B, Gharaibeh M, Al Alakhras M. Knowledge and practice of radiation protection in the operating theater among orthopedic surgeons. J Med Imaging (Bellingham) 2022;9(6):066002.
https://doi.org/10.1117/1.JMI.9.6.066002
21. Joeris A, Goldhahn S, Kalampoki V, Gebhard F. Intraoperative radiation exposure of orthopaedic surgeons –
Mismatch between concerns and protection. Occup Med Health Aff 2018;6:273. https://doi.org/10.4172/2329-6879.1000273
22. Pires RE, Reis IGN, de Faria ÂRV, Giordano V, Labronici PJ, Belangero WD. The hidden risk of ionizing radiation
in the operating room: a survey among 258 orthopaedic surgeons in Brazil. Patient Saf Surg 2020;14:16.
https://doi.org/10.1186/s13037-020-00238-6
23. Saroki AJ, Wijdicks C, Philippon MJ, Bedi A. Orthopaedic surgeons’ use and knowledge of ionizing
radiation during surgical treatment for femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc
2015;24(12):3962-70. https://doi.org/10.1007/s00167-015-3734-1
Acad Orthop Surg 2018;26(8):268-77. https://doi.org/10.5435/JAAOS-D-16-00342
2. Matityahu A, Duffy RK, Goldhahn S, Joeris A, Richter PH, Gebhard F. The great unknown-A systematic literature
review about risk associated with intraoperative imaging during orthopaedic surgeries. Injury 2017;48(8):1727-34. https://doi.org/10.1016/j.injury.2017.04.041
3. Giordano BD, Grauer JN, Miller CP, Morgan TL, Rechtine GR 2nd. Radiation exposure issues in orthopaedics. J
Bone Joint Surg Am 2011;93(12):e69(1-10). https://doi.org/10.2106/JBJS.J.01328
4. Ojodu I, Ogunsemoyin A, Hopp S, Pohlemann T, Ige O, Akinola O. C-arm fluoroscopy in orthopaedic surgical
practice. Eur J Orthop Surg Traumatol 2018;28(8):1563-8. https://doi.org/10.1007/s00590-018-2234-7
5. The 2007 Recommendations of the International Commission on Radiological Protection: ICRP publication 103.
Ann ICRP 2007;37(2-4):1-332. Disponible en: https://www.nrc.gov/docs/ML1233/ML12338A682.pdf
6. Frane N, Megas A, Stapleton E, Ganz M, Bitterman AD. Radiation exposure in orthopaedics. JBJS Rev 2020;8(1):
e0060. https://doi.org/10.2106/JBJS.RVW.19.00060
7. Kaplan DJ, Patel JN, Liporace FA, Yoon RS. Intraoperative radiation safety in orthopaedics: a review of the
ALARA (As low as reasonably achievable) principle. Patient Saf Surg 2016;10:27. https://doi.org/10.1186/s13037-016-0115-8
8. Baumgartner R, Libuit K, Ren D, Bakr O, Singh N, Kandemir U, et al. Reduction of radiation exposure from C-arm fluoroscopy during orthopaedic trauma operations with introduction of real-time dosimetry. J Orthop Trauma 2016;30(2):e53-8. https://doi.org/10.1097/BOT.0000000000000442
9. Mastrangelo G, Fedeli U, Fadda E, Giovanazzi A, Scoizzato L, Saia B. Increased cancer risk among surgeons in an orthopaedic hospital. Occup Med (Lond) 2005;55(6):498-500. https://doi.org/10.1093/occmed/kqi048
10. Chou LB, Chandran S, Harris AH, Tung J, Butler LM. Increased breast cancer prevalence among female orthopedic surgeons. J Womens Health (Larchmt) 2012;21(6):683-9. https://doi.org/10.1089/jwh.2011.3342
11. Chou LB, Johnson B, Shapiro LM, Pun S, Cannada LK, Chen AF, et al. Increased prevalence of breast and all-cause cancer in female orthopaedic surgeons. J Am Acad Orthop Surg Glob Res Rev 2022;6(5):e22.00031.
https://doi.org/10.5435/JAAOSGlobal-D-22-00031
12. Vanoli F, Gentile L, Iglesias SL, Lobos Centeno E, Diaz MP, Allende Nores CA. Exposición a la radiación de los
cirujanos en la fijación interna de fracturas de radio distal. Rev Asoc Argent Ortop Traumatol 2017;82(4):271-7.
https://doi.org/10.15417/674
13. Bazán PL, Muscia R, Gomez Cano J, Corrales Pinto J, Borri AE, Medina M, et al. Incidencia de la exposición a los
rayos X en cirugías de columna. Rev Asoc Argent Ortop Traumatol 2019;84(3):208-15. https:/doi.org/10.15417/issn.1852-7434.2019.84.3.884
14. Vivas M, Herrera H, Guyot JP, Santini Araujo G, Dello Ruso B, Castellini J. Informe sobre la radio-exposición en
el personal quirúrgico de Ortopedia y Traumatología. Principios, marco legal y análisis situacional en la Argentina. Rev Asoc Argent Ortop Traumatol 2018;83(3):210-3. https://doi.org/10.15417/issn.1852-7434.2018.83.3.821
15. Gausden EB, Christ AB, Zeldin R, Lane JM, McCarthy MM. Tracking cumulative radiation exposure in orthopaedic surgeons and residents: what dose are we getting? J Bone Joint Surg Am 2017;99(15):1324-9.
https://doi.org/10.2106/JBJS.16.01557
16. Burns S, Thornton R, Dauer LT, Quinn B, Miodownik D, Hak DJ. Leaded eyeglasses substantially reduce radiation exposure of the surgeon’s eyes during acquisition of typical fluoroscopic views of the hip and pelvis. J Bone Joint Surg Am 2013;95(14):1307-11. https://doi.org/10.2106/JBJS.L.00893
17. Kesavachandran CN, Haamann F, Nienhaus A. Radiation exposure of eyes, thyroid gland and hands in orthopaedic staff: a systematic review. Eur J Med Res 2012;17(1):28. https://doi.org/10.1186/2047-783X-17-28
18. Meisinger QC, Stahl CM, Andre MP, Kinney TB, Newton IG. Radiation protection for the fluoroscopy operator and staff. AJR Am J Roentgenol 2016;207(4):745-54. https://doi.org/10.2214/ajr.16.16556
19. Hoffler CE, Ilyas AM. Fluoroscopic radiation exposure: are we protecting ourselves adequately? J Bone Joint Surg Am 2015;97(9):721-5. https://doi.org/10.2106/JBJS.N.00839
20. Al Mohammad B, Gharaibeh M, Al Alakhras M. Knowledge and practice of radiation protection in the operating theater among orthopedic surgeons. J Med Imaging (Bellingham) 2022;9(6):066002.
https://doi.org/10.1117/1.JMI.9.6.066002
21. Joeris A, Goldhahn S, Kalampoki V, Gebhard F. Intraoperative radiation exposure of orthopaedic surgeons –
Mismatch between concerns and protection. Occup Med Health Aff 2018;6:273. https://doi.org/10.4172/2329-6879.1000273
22. Pires RE, Reis IGN, de Faria ÂRV, Giordano V, Labronici PJ, Belangero WD. The hidden risk of ionizing radiation
in the operating room: a survey among 258 orthopaedic surgeons in Brazil. Patient Saf Surg 2020;14:16.
https://doi.org/10.1186/s13037-020-00238-6
23. Saroki AJ, Wijdicks C, Philippon MJ, Bedi A. Orthopaedic surgeons’ use and knowledge of ionizing
radiation during surgical treatment for femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc
2015;24(12):3962-70. https://doi.org/10.1007/s00167-015-3734-1