Effect of metallic tools on scattered radiation dose during the use of C-arm fluoroscopy in orthopaedic surgery

This study investigated the effect of metallic tools on the scattered radiation dose delivered to surgeons' radiosensitive organs while simulating hip surgery using C-arm fluoroscopy. Two phantoms, a pelvis and a Rando phantom, were used to simulate a patient and a surgeon in this study. Photoluminescence dosimeters were inserted into the Rando phantom in the positions of the eye, thyroid and gonad. A drill was positioned above the hip of the pelvis phantom or beside the pelvis phantom of the same height. For each drill location, the scattered radiation dose was measured when the angle to the operator phantom was 45°; this was repeated when the angle was 90°. The scattered radiation doses to the eye, thyroid and gonad when the drill was placed beside the pelvis phantom with 90° angulation to the operator phantom were significantly lower than the reference values and those when the drill was placed beside the pelvis phantom at a 45° angulation to the operator phantom. The scattered radiation doses to the eye and thyroid when the drill was placed above the hip were significantly lower than the references values. Of the four different scenarios, the scattered radiation doses to the eye, thyroid and gonad were lowest when the drill was placed beside the pelvis phantom with 90° angulation. This study showed that the scattered radiation doses to radiosensitive organs were affected by the location and angle of the metallic tools in relation to the operator. Therefore, orthopedic surgeons should consider the effect of metallic tools on the scattered radiation dose during intraoperative use of C-arm fluoroscopy.