Treffer: Insights into Testicular Radiation Exposure in the Orthopedic Surgeon.
Original Publication: New York.
Athwal GS, Bueno RA Jr, Wolfe SW. Radiation exposure in hand surgery: mini versus standard C-arm. J Hand Surg Am 30:1310–1316; 2005.
Bae MJ, Kang MK, Kye YU, Baek JH, Sim YJ, Lee HJ, Kang YR, Jo WS, Kim JS, Lee CG. Differential effects of low and high radiation dose rates on mouse spermatogenesis. Int J Mol Sci 22:12834; 2021.
Bowman JR, Razi A, Watson SL, Pearson JM, Hudson PW, Patt JC, Ames SE, Leddy LR, Khoury JG, Tubb CC, McGwin G, Ponce BA. What leads to lead? Results of a nationwide survey exploring attitudes and practices of orthopaedic surgery residents regarding radiation safety. J Bone Joint Surg 100:e16; 2018.
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 95:1307–1311; 2013.
Chou LB, Johnson B, Shapiro LM, Pun S, Cannada LK, Chen AF, Valone LC, Van Nortwick SS, Ladd AL, Finlay AK. Increased prevalence of breast and all-cause cancer in female orthopaedic surgeons. J Am Acad Orthop Surg Glob Res Rev 6:e22; 2022.
De Felice F, Marchetti C, Marampon F, Cascialli G, Muzii L, Tombolini V. Radiation effects on male fertility. Androl 7:2–7; 2019.
Dorman T, Drever B, Plumridge S, Gregory K, Cooper M, Roderick A, Arruzza E. Radiation dose to staff from medical x-ray scatter in the orthopaedic theatre. Eur J Orthop Surg Traumatol. 33:3059–3065; 2023.
European Union. Official Journal of the European Union [online]. 2014. Available at eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri = OJ:L:2014:013:FULL . Accessed 9 October 2024.
Fidan F, Çetin M, Kazdal C, Kiliç F, Özkaya U. Behaviour and knowledge skill levels of orthopedic surgeons about radiation safety and fluoroscopy use: a survey analysis. Acta Orthop Traumatol Turc 53:301–305; 2019.
Fryar CD, Carroll MD, Gu Q, Afful J, Ogden CL. Anthropometric reference data for children and adults: United States, 2015-2018. Vital Health Stat 3:1–44; 2021.
Giordano BD, Grauer JN, Miller CP, Morgan TL, Rechtine GRI. Radiat Exposure Issues Orthopaed JBJS 93:e69; 2011.
Hoffler CE, Ilyas AM. Fluoroscopic radiation exposure: are we protecting ourselves adequately? J Bone Joint Surg Am 97:721–725; 2015.
Igrek S, Şahbat Y, Akgulle AH, Erol B. Does radiation exposure during pediatric supracondylar humeral fracture surgery change according to the C-arm position? A comparison of two different techniques. Injury 54:110962; 2023.
Institute of Medicine. Potential radiation exposure in military operations: protecting the soldier before, during, and after. Washington, DC: The National Academies Press; 1999.
Kesari KK, Agarwal A, Henkel R. Radiations and male fertility. Reprod Biol Endocrinol 16:118; 2018.
Krille L, Hammer GP, Merzenich H, Zeeb H. Systematic review on physician's knowledge about radiation doses and radiation risks of computed tomography. Eur J Radiol 76:36–41; 2010.
Massey PA, Myers ME, Guedry RD, Lowery MT, Perry KJ, Barton RS. Improved radiation exposure monitoring of orthopaedic residents after institution of a personalized lead protocol. JBJS Open Access 7:e21.00115; 2022.
McBride WH, Schaue D. Radiation-induced tissue damage and response. J Pathol 250:647–655; 2020.
Mehlman CT, DiPasquale TG. Radiation exposure to the orthopaedic surgical team during fluoroscopy: “how far away is far enough?”. J Orthop Trauma 11:392–398; 1997.
National Council on Radiation Protection and Measurements. Limitation of exposure to ionizing radiation recommendations. Bethesda, MD: National Council on Radiation Protection and Measurements; 1993.
Merzenich H, Krille L, Hammer G, Kaiser M, Yamashita S, Zeeb H. Paediatric CT scan usage and referrals of children to computed tomography in Germany—a cross-sectional survey of medical practice and awareness of radiation related health risks among physicians. BMC Health Serv Res 12:47; 2012.
Miller ME, Davis ML, MacClean CR, Davis JG, Smith BL, Humphries JR. Radiation exposure and associated risks to operating-room personnel during use of fluoroscopic guidance for selected orthopaedic surgical procedures. J Bone Joint Surg Am 65:1–4; 1983.
Mohan AK, Hauptmann M, Freedman DM, Ron E, Matanoski GM, Lubin JH, Alexander BH, Boice JD Jr, Doody MM, Linet MS. Cancer and other causes of mortality among radiologic technologists in the United States. Int J Cancer 103:259–267; 2003.
National Institute of Health National Cancer Institute Surveillance, Epidemiology and end results program. SEER*Stat Databases: SEER November 2023 Submission [online]. 2023. Available at https://seer.cancer.gov . Accessed 9 October 2024.
Noel OF, Berg A, Onyango N, Mackay DR. Ethnic and gender diversity comparison between surgical patients and caring surgeons. Plast Reconstr Surg Glob Open 8:e3198; 2020.
Norris TG. Radiation safety in fluoroscopy. Radiol Technol 73:511–533; quiz 534-516, 566; 2002.
Rehani MM, Ciraj-Bjelac O, Vano E, Miller DL, Walsh S, Giordano BD, Persliden J. Radiological protection in fluoroscopically guided procedures outside the imaging department. Annals ICRP 40:1–102; 2010.
Rice HE, Frush DP, Harker MJ, Farmer D, Waldhausen JH. Peer assessment of pediatric surgeons for potential risks of radiation exposure from computed tomography scans. J Pediat Surg 42:1157–1164; 2007.
Rohde RS, Wolf JM, Adams JE. Where are the women in orthopaedic surgery? Clin Orthop Relat Res 474:1950–1956; 2016.
Singer G. Occupational radiation exposure to the surgeon. J Am Acad Orthop Surg 13:69–76; 2005.
Theocharopoulos N, Perisinakis K, Damilakis J, Papadokostakis G, Hadjipavlou A, Gourtsoyiannis N. Occupational exposure from common fluoroscopic projections used in orthopaedic surgery. J Bone Joint Surg Am 85:1698–1703; 2003.
Thomas KE, Parnell-Parmley JE, Haidar S, Moineddin R, Charkot E, BenDavid G, Krajewski C. Assessment of radiation dose awareness among pediatricians. Pediatr Radiol 36:823–832; 2006.
Tunçer N, Kuyucu E, Sayar Ş, Polat G, Erdil İ, Tuncay İ. Orthopedic surgeons' knowledge regarding risk of radiation exposition: a survey analysis. Sicot J 3:29; 2017.
United States Nuclear Regulatory Commission. Subpart C—occupational dose limits [online]. 2021. Available at https://www.nrc.gov/reading-rm/doc-collections/cfr/part020/part020-1201.html . Accessed 9 October 2024.
Vakalopoulos I, Dimou P, Anagnostou I, Zeginiadou T. Impact of cancer and cancer treatment on male fertility. Hormones (Athens) 14:579–589; 2015.
Valone LC, Chambers M, Lattanza L, James MA. Breast radiation exposure in female orthopaedic surgeons. J Bone Joint Surg Am 98:1808–1813; 2016.
Wan RC, Chau WW, Tso CY, Tang N, Chow SKH, Cheung WH, Wong RMY. Occupational hazard of fluoroscopy: an invisible threat to orthopaedic surgeons. J Orthopaedics, Trauma and Rehab 1–13: 2021. doi:10.1177/22104917211035547. (PMID: 10.1177/22104917211035547)
Wdowiak A, Stec M, Raczkiewicz D, Bien A, Iwanowicz-Palus G, Panasiuk L. Background ionizing radiation and semen parameters of men with reproductive problems. Ann Agric Environ Med 27:43–48; 2020.
Wong CS, Huang B, Sin HK, Wong WL, Yiu KL, Chu Yiu Ching T. A questionnaire study assessing local physicians, radiologists and interns’ knowledge and practice pertaining to radiation exposure related to radiological imaging. Eur J Radiol 81:e264–268; 2012.
Yamashita K, Tamaki Y, Nakajima D, Omichi Y, Takahashi Y, Takai M, Goto T, Hayashi H, Higashino K, Tsuruo Y, Sairyo K. A cadaveric simulation study of radiation exposure to the surgical team during fluoroscopic spinal surgery: how much are we exposed? Spine Surg Relat Res 7:341–349; 2023.
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Testicular radiation exposure has been linked to diminished spermatogenesis, male infertility, and potentially testicular cancer. Despite this, the risk of testicular exposure from intraoperative fluoroscopy to the male orthopedic surgeon has yet to be studied. The purpose of this study is to determine factors associated with unnecessary testicular radiation exposure in male orthopedic surgeons. The study was designed to answer the following questions: (1) Do the designs of lead apron protection result in any differential testicular radiation exposure? (2) Does the position of the surgeon (standing, sitting, and knee position while sitting) alter the amount of testicular radiation exposure? (3) Does any combination of lead apron design and surgeon positioning increase the degree of testicular radiation exposure? A life-sized, whole-body, anthropomorphic phantom simulating an orthopedic surgeon was positioned adjacent to a hand table attached to a standard radiolucent operating table. A digital dosimeter was attached to the groin region beneath a lead apron. Scatter radiation dose equivalent rates were measured during continuous anteroposterior C-arm fluoroscopy of a forearm/hand phantom. Four trials were conducted using three different types of protective lead aprons (cross-back, full-skirt, and half-skirt) in three different positions (standing, sitting with knees 10 cm apart, and sitting with knees 25 cm apart). Radiation dose-equivalent rates were compared using the Student's t-test and analysis of variance. No scatter radiation (measured value of 0.0 mrem min -1 [0.0 Sv min -1 ]; below minimum detectability of dosimeter) was detected underneath the lead aprons in the standing position and when sitting with the knees 25 cm apart, using all three types of lead. When sitting with the knees 10 cm apart, the mean dose equivalent rate of scatter radiation was higher using the half-skirt (0.01 mrem min -1 [0.000001 Sv min -1 ]) than the cross-back (below minimum detectability of dosimeter) and skirt aprons (below minimum detectability of dosimeter), but this did not reach statistical significance (p = 0.44). For all apron types and all positions, the use of an apron resulted in significantly less scatter radiation exposure when compared to no protection (p < 0.001). Protective lead aprons are effective at preventing testicular radiation exposure in both the standing and sitting positions. As the only detectable radiation exposure occurred with use of a half-skirt apron when sitting with the knees spread 10 cm apart, cross-back and full-skirt aprons may provide slightly enhanced protection over half-skirt aprons in the sitting position.
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Authors declare no Conflict of Interest.