Radiation Safety

Radiation Safety Education in Operating Theaters

What are the risks of radiation exposure in the operating theatre? How can hospitals encourage their staff to minimize exposure levels?


The surgical field has advanced rapidly during the past decade. Scientists and researchers in the medical field have made substantial efforts to equip the operating theater with new and innovative surgical techniques.

For instance, many surgical techniques used in the operating theater include diagnostic and therapeutic radiology procedures such as angiography, cardiology, or orthopedic surgery. Although these techniques benefit patients, protection against radiation for the staff is still a problem.

In today's article, we will discuss the dangers of ionizing radiation in the operating theater and why educating the staff and encouraging them to use measures to ensure radiation safety is so important.

Risks of Radiation Exposure in the Operating Theater

Fluoroscopic procedures and interventional methods used in the operating theater can cause patients to receive higher radiation doses. These doses depend on the procedure type, the time involved, tools or equipment used, patient's size, among other factors.

Receptor entrance and skin exposure rate management ensure safe patient exposure. The staff also focus on clinical monitoring of doses. Radiation emitted during diagnostic procedures (fluoroscopy) contributes to radiation dose for the operating room's staff.

Radiation risks can be categized into two categories. Deterministic (non-stochastic) and non-deterministic (stochastic) effects.

operating theater for cataracts surgery

Simply speaking, deterministic effects are problems such as cataracts that we know will happen after a certain dose or threshold of ionizing radiation. These are directly related to the absorbed radiation dose and the severity of the effect increases as the dose increases.

Non-deterministic occur by chance, generally occurring without a threshold level of dose. The chance of occurrence of stochastic effects is proportional to the dose but the severity of the effect is independent of the dose received.

Some of the common radiation-induced problems are thyroiditis, dermatitis, and hair loss. Radiation exposure can cause significant damage to the DNA, leading to cancer development, known as the stochastic effect.

The Importance of Radiation Safety Education

The medical community needs to focus on protecting operating theater staff from radiation and its side effects. The first step toward radiation safety is educating the team on best practices. Each hospital's radiation safety department should educate the theater personnel and run refresher courses to ensure the safety of the workforce.

Research shows that healthcare institutions that promote education practices and protocol development strategies can mitigate the harmful effects of radiation. For instance, hospitals can use different resources, including video-based training and Virtual Reality simulation,  to educate the staff and encourage them to implement practices that reduce fluoroscopy time by 50%.

Bear in mind that optimization and adherence to dosage limitation can decrease exposure when followed. It is crucial for hospitals, particularly the operating room staff, to follow the ALARA principle, requiring the team to confirm the benefits of radiation exposure outweigh the risks.

The duration of radiation exposure, distance from the source, and physical shielding are crucial facets in reducing exposure. However, the hospital or health institution must educate the operating room staff to minimize the exposure durations. Researchers recommend the following practices for radiation safety.

Preplan the Required Images

The physician, surgeon, or technician should preplan the required images when exposing patients to radiation. The purpose is to avoid redundant exposure. Magnification increases the radiation exposure to the patient, meaning health professionals should use this method judiciously.

The medical staff can use live fluoroscopy to understand anatomy during surgical procedures. The problem is that standard fluoroscopy machines can process no more than 35 images per second.

The operating room staff can use pulsed fluoroscopy to decrease radiation exposure, capturing five images per second without compromising the quality. The medical staff should make efforts to limit exposure duration whenever possible.

Proper X-ray Tube Positioning in relation to Staff Positions

Operating room staff can lower their radiation exposure levels by increasing their distance two times from the source. Research highlights that this is a straightforward method to reduce occupational radiation exposure. Sadly it’s not as simple as that…

Educating the staff on proper X-ray tube positioning is essential. The staff must increase their distance from the x-ray beam. But how do they know where the most intense parts of this beam are? Ionizing radiation is invisible to the human eye and it is difficult to calculate the effects of the primary beam and the scatter radiation especially as it is invisible and the surgical team will be concentrating on other aspects of their role. Perhaps a medical physicist could describe the Isodose curves of the radiation but not many others!

Mini C-Arm

A growing body of research evidence shows that the mini-C-arm can result in minimal scatter radiation exposure for operating room staff, including surgeons and nurses. This decrease in radiation exposure is extrinsic to the C-arm size. Imaging smaller body parts results in decreased scatter radiation exposure and relative safety.

It is because the staff holds the intensifier at lower kilo-voltage settings. Research shows that a mini C-arm used for imaging body parts in the same configuration as a standard C-arm leads to 70% greater scatter radiation exposure. The use of a mini C-arm instead of a standard C-arm must not alter a surgeon's vigilance for radiation safety.

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Personal Protective Equipment

The hospital's administration should establish strict policies regarding personal protective equipment to ensure physical radiation shielding in the operating theater. Some fluoroscopy suites contain lead acrylic shields that can reduce the dose ten times to the health professional's head and neck.

Portable Rolling Shields

Surgeons and nurses can use portable rolling shields to protect themselves in operating theaters and interventional settings. Many research studies have confirmed the efficacy of these mobile shields in decreasing the radiation dose to staff. One study shows that portable rolling shields can reduce radiation dose by 90% if used correctly.

“Leaded” Aprons

In addition to any physical barriers, the staff should wear leaded aprons to reduce the risk of radiation exposure. Healthcare institutions should support educational interventions and train their staff to use proper personal protective equipment, including leaded aprons.

The operating room staff requires leaded aprons in different situations, and these come in 0.25mm, 0.35mm, and 0.5mm thicknesses. We recommend using aprons that wrap circumferentially around your body for increased surface area coverage. Generally, the radiation transmission through these aprons is between 0.5% and 5%.

“Leaded” Glasses

Although leaded glasses are the least worn piece of personal protective equipment, they can protect the operating theatre staff from cataract development. Studies show that regular use of leaded glasses can decrease radiation exposure by 90%. Therefore, it's the hospital's responsibility to educate the staff and encourage them to wear leaded glasses for reduced radiation exposure.

Final Words

The operating theater staff is routinely exposed to intraoperative radiation, leading to a wide range of health complications. Therefore, it is crucial to make efforts to minimize occupational radiation exposure levels.

Hospitals and health institutions can play a significant role in educating their medical and surgical staff to wear personal protective equipment and implement other essential methods to reduce radiation. Until Next Time!

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