Presented by: Jacob Thatcher DO
Jefferson New Jersey

Introduction

Fluoroscopy is an important tool in endourology. Residents spend a significant amount of time using fluoroscopy. Using extrapolated data collected from our OR using real time Geiger counters we showed that despite using low dose technology, leaded aprons and thyroid shields, the standard dose a resident receives over one year is 11% over the annual total radiation dose limit to the eyes and near the annual total dose radiation for the entire body. This doesn’t include the omnipresent ambient radiation exposure. The aim of our current study is to investigate the reduction in radiation exposure to the primary surgeon and anesthesia when a lead skirt is installed around the table.

Materials

We placed lead skirts circumferentially around the operating room table and using the Radex One Quarta Geiger Dosimeters at the level of the eyes, buttocks, anesthesia outer chest pocket and adjacent to the x-ray tube we collected real time radiation exposure for each procedure. We compared these data with data collected using the same configuration without the lead operating room table skirt.

Results

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Radiation exposure to various body parts during eighty-one endourologic procedures over a six-month period was tabulated. The normalized average was then compared. The highest amount of radiation received was to the eyes - 8.42μGy, followed by groin - 1.76μGy, backside - 1.53μGy, and inner chest - 1.07μGy per procedure. By simply installing a leaded skirt around the four sides of the table, we show that this attenuates the scattered dose radiation to all areas. Most notably, the reduction in radiation to the eyes is reduced from 8.42 to 1.46, a nearly 500% reduction in radiation (table 1). Similarly, radiation to the buttocks is reduced by almost 200%. This data reflects a potential intervention that is simple, cost effective and revolutionary in fluoroscopy.

Conclusion

Residents are exposed to high amounts of radiation during fluoroscopic procedures, which could be harmful. Dose exposure varies by body region. We show that the radiation to anesthesia is nearly equivalent to that of the primary surgeon. Installing a lead skirt around the table significantly reduces radiation scatter in the operating room. This represents a cheap and practical intervention to improve operating room safety. This intervention can be implemented across multiple specialties.

Funding

Osteopathic Heritage Grant, Rowan University School of Medicine

Lead Authors

Thomas Mueller, MD
New Jersey Urology