Current orthopaedic practice involves an increasing use of operative fluoroscopic screening and radiation exposure. The AOA produces a booklet entitled “Radiation safety for orthopaedic surgeons” outlining the risks. There is a disparity between guidelines and actual clinical practice for trainee registrars.

Aims:

To measure trainee fluoroscopy usage with and without consultants present.

To audit trainees and hospitals adherence to the guidelines

All procedures in a 6 month period using II were analysed. Data for Procedure, Operating Surgeon, First Assistant and if Consultant Surgeon was present or absent was collected. Fluoroscopic Exposure Time was also recorded.

Procedures were grouped and times compared depending on the staff present. There were 121 cases included in the study. 44 cases were performed by the trainee with the consultant assisting and 76 were performed in the absence of the consultant.

A questionnaire based on the AOA guidelines was produced. All NSW advanced trainees in Orthopaedic surgery were asked to complete the anonymous questionnaire.

There was a significant difference of 32.18 seconds in mean exposure time per case with a p-value 0.0069 where the consultant was present or not. There was also a significant difference between consultants doing the same cases.

Other very significant findings were:

97% of trainees were not aware of the maintenance and inspection schedules equipment.

97% of trainees have practiced the incorrect technique of using the image receptor of the II machine as an operating table which maximizes scatter to the head and neck

65% regularly use continuous screening of II

65% admit to taking unnecessary II shots to ensure the perfect xray.

32% of trainees wore no thyroid protection, 87% no eye protection and 100% used no head and hand protection.

One registrar was exposed to 8131 seconds of II exposure during his 6 month rotation. Without the use of lead protection, the trainee registrar will have exceeded the annual limit of whole body exposure (20mSv/year) by more than 2-fold.

Dramatic decreases in exposure can be achieved by better discipline with the usage of II. This needs to be a fundamental part of registrar training.

The survey shows trainees are not aware, or fail to adhere to current guidelines and that hospitals are not providing appropriate safety equipment and not insisting that staff exercise safe practices.