AUDIT OF RADIATION EXPOSURE IN A LEVEL 1 TRAUMA UNIT – A REVIEW OF 1709 ORTHOPAEDIC CASES

Abstract

Introduction: The Ionising Radiations Medical Exposure Regulations Act 2000 has established diagnostic reference levels for radiological examinations, however at present there are no national guidelines available for orthopaedic trauma surgery. There may be a role for the introduction of diagnostic reference levels at a local level therefore we studied patient area dose and screening time for orthopaedic trauma operations performed in the Regional Trauma Centre in Northern Ireland.

Methods: Retrospectively data was retrieved from written radiography records in the Royal Victoria Hospital, during the period of 1st January 2007 to 31st December 2007 for all orthopaedic trauma cases in which an image intensifier was used. The screening time, patient area dose (PAD), details of the operation, patient age, sex, month of the operation and grade of the operating surgeon (trainee or consultant), were recorded.

Results: 1709 cases using image intensifier were reviewed. 137 cases were excluded due to incomplete data. 319 hips were screened for insertion of sliding hip screw, mean screening time was 0.51min with a mean PAD of 145cGycm2. 127 femoral nails were inserted with an average screening time of 1.84min and mean PAD of 310cGycm2. 166 tibias were screened for application of Ilizarov frame or insertion of tibial nail, average screening time was 3.00min with a mean PAD of 48cGycm2. 129 spinal cases were screened with an average screening time of 0.80mins and mean PAD of 37.9cGycm2. Consultants had lower screening times and mean PADs than trainees with 0.63min versus 1.01min and 65.8cGycm2 versus 70.9cGycm2.

Conclusions: The average screening times and mean PADs compared favourably with local reference guides for image intensifier cases and with other published series. Every trauma unit should have local reference ranges for orthopaedic imaging cases and regular audit should be carried out to assess compliance with these ranges.