(radiation) Prospective Assessment of the Oncogenic Risk to Patients from Fluoroscopy during Trauma Surgery

abstract

OBJECTIVE:

Concern about radiation exposure during surgery has focused on surgeon exposure. However, the patient receives exposure that is more direct and, in surgery about the pelvis and hip, internal pelvic non-skeletal organs often cannot be shielded without obscuring the region of surgical interest. The purpose of this study was to prospectively evaluate patients' radiation exposure during fracture surgery of the acetabulum, pelvic ring, and femur to calculate future cancer incidence (CI).

DESIGN:

Prospective Descriptive Cohort SETTING:: Level One Trauma Center PATIENTS/PARTICIPANTS:: 108 patients with acetabulum, pelvic, or femur fractures requiring operative repair were prospectively enrolled.

INTERVENTION:

Dosimeters were placed in locations determined for each surgery type by a medical physicist.

MAIN OUTCOME MEASUREMENTS:

Demographics, operative records, and average x-ray emission energy were recorded. Effective dose (ED), specific organ doses, and lifetime cancer incidence (CI) for a 30-year-old patient were calculated.

RESULTS:

Diagnoses included 27 acetabular fractures, 30 intertrochanteric femur fractures, 26 femoral shafts, and 25 pelvic ring injuries. Patients with pelvic ring injuries received the highest ED at 0.91 ± 0.74 mSv. The average lifetime increase in CI, for any cancer type, after pelvic ring fixation is 0.0097% for females and 0.0062% for males. The greatest mean single-organ dose to the ovaries (3.82 ± 3.34 mGy) occurred during pelvic ring surgery, correlating to an increased ovarian cancer risk of 0.0013%. The greatest mean single-organ dose to the prostate (6.81 ± 5.91 mSv) also occurred during pelvic surgery, correlating to increased prostate cancer risk of 0.0024%

CONCLUSIONS:: Fracture surgery to the pelvis and femur are exceptionally fluoroscopy-dependent; however, the radiation exposure incurred represents a relatively small increased risk of future cancer development in patients.