Image-guided Reconstruction of Femoral Fractures Is the Staff Progeny Safe? Nicholas Theocharopoulos, MSc; John Damilakis, PhD; Kostas Perisinakis, PhD; George Papadokostakis, MD; Alexander Hadjipavlou, MD; and Nicholas Gourtsoyiannis, MD The potential of adverse effects to progeny caused by pre- conceptual and fetal exposure to ionizing radiation is an issue of increasing concern to orthopaedic surgeons and assisting staff. Are these fears justified? How effectively is the embryo or fetus protected, and should pregnant staff alter their du- ties? In this study, an anthropomorphic phantom was ex- posed fluoroscopically at two geometries common in surgical reconstruction of proximal femur fractures. Scatter radia- tion was converted to gonadal dose and embryo or fetal dose with and without use of a protective apron. The genetic risk for the orthopaedic surgeon after 10 years of occupational exposure was estimated to be 16,000 times lower than the natural frequency of heritable disease. The excess risk of childhood cancer associated with the dose accumulated dur- ing gestation was at least 600 times lower than the corre- sponding natural frequency. A properly shielded pregnant orthopaedic surgeon is allowed to do 14 hours of hip fluo- roscopy during gestation, whereas 2100 hours of fluoroscopy are required for the induction of gross malformation or men- tal retardation to the growing embryo or fetus. The supple- mentary dose constraints for pregnant staff provide ad- equate protection to the unborn child without affecting regu- lar personnel duties. Fluoroscopy is an imaging modality with extensive use in orthopaedic applications. The advent of mobile C-arm fluoroscopes and the introduction of new image-guided surgical procedures have increased the exposure of trauma field personnel to radiation. Moreover, a constant rise in femoral and hip fractures, which require surgical recon- struction under fluoroscopic guidance, has been re- ported. 2,4,9,20 Previous studies have analyzed scattered ra- diation in the orthopaedic surgical field and investigated the correlation between distance from the patient and staff exposure. 1,7,14 The effect of the experience of the surgeon and the radiographer on administered radiation doses, the relationship between the complexity of the fracture, and the duration of fluoroscopic imaging have been exam- ined. 8 Maximum permissible workloads for orthopaedic staff also have been reported. 21 However, operating orthopaedic surgeons and assisting staff are not only concerned about the deleterious somatic effects of radiation, 10 but also the potential adverse effects on reproduction attributable to preconceptual exposure. Moreover, occupational exposure to radiation during preg- nancy is a major factor of anxiety for expectant staff in the medical sector. Are these fears justified? The important topic of radiation safety for the offspring of the staff re- mains to be addressed. A series of key questions are: What are the gonadal doses to the staff and what are the asso- ciated radiogenic risks? What are the maximum permis- sible workloads for pregnant personnel? Do the supple- mentary dose limits, which apply during gestation, effec- tively protect the embryo or fetus? How can the radiation dose to the embryo or fetus be assessed? and Does the implementation of pregnancy workloads necessitate major changes in staff duties, and what are the practical measures that could minimize the dose to the embryo or fetus? Previous data on gonadal doses to orthopaedic depart- ment personnel are sporadic and insufficient for estimation of the genetic burden. To our knowledge, there are no reported data regarding embryo or fetal doses from scat- tered radiation during fluoroscopically guided surgical treatments of the femur. Our aim in the current study was to map the levels of scattered radiation within the ortho- paedic surgical field from the fluoroscopic projections commonly used to guide surgical reconstruction of proxi- Received: December 17, 2003 Revised: March 29, 2004 Accepted: July 16, 2004 From the Department of Medical Physics, Faculty of Medicine, University of Crete, Crete, Greece. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrange- ments, etc) that might pose a conflict of interest in connection with the submitted article. Correspondence to: John Damilakis, PhD, Department of Medical Physics, Faculty of Medicine, University of Crete, PO Box 1393, 71500 Iraklion, Crete, Greece. Phone: 30-2810-392564; Fax: 30-2810-542095; E-mail: damilaki@med.uoc.gr. DOI: 10.1097/01.blo.0000143740.15255.82 CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 430, pp. 182–188 © 2005 Lippincott Williams & Wilkins 182