Assessment of radiation dose values in common orthopaedic trauma examinations performed under X-ray fluoroscopy guidance

Abstract

This study aims to provide radiation reference levels in orthopaedic surgery. A total of 753 procedures were collected within 1 y. Categories containing several similar procedures were created based on four criteria: same anatomical area, same level of complexity, only single procedures, and at least 10 cases per category. Exposure was defined in terms of air kerma-area product, fluoroscopy time, and air kerma at the patient entrance reference point. For common procedures, median effective doses to patient were calculated using the Monte Carlo Software PCXMC. Most irradiating procedure in this study i.e. intramedullary nailing of the proximal femur was equivalent to an air kerma at the patient entrance reference point of 37.1 mGy, which is ∼50 times lower than the threshold for acute deterministic effects of radiation. Optimization remains a must to reduce the dose while maintaining the image quality and reducing the likelihood of stochastic effects.