AANA Lab Course 907-Arthroscopic/Open Strategies - Hip Preservation-Radiation Safety and Hip Arthroscopy-Brian Giordano, MD

Radiation Safety and Hip Arthroscopy-Brian Giordano, MD

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This presentation by Dr. Brian D. Giordano highlights radiation safety concerns associated with hip arthroscopy, focusing on occupational and patient exposures. Ionizing radiation has been used medically since 1895, with mobile fluoroscopy becoming common in orthopedics since the 1980s. Radiation serves key roles in orthopedics for diagnosis, fracture evaluation, implant placement, alignment, and surgical joint access.<br /><br />Sources of radiation exposure include direct and scattered radiation from plain radiographs, arthrograms, fluoroscopy (mini and large C-arm), CT scans, and nuclear medicine. Radiation dosage is measured as effective dose (in Sieverts or rem), considering tissue sensitivity, and cumulative exposure can increase lifetime cancer risk.<br /><br />Radiation safety is often overlooked because radiation is invisible, odorless, silent, and has no immediate effects. Orthopedic surgeons have up to a fivefold increased cancer risk, with occupational limits set at 5 rem/year. Patients lack established exposure limits. Radiation to patients and OR staff correlates with body part size, tissue density, and imaging techniques. Even at recommended distances, staff exposure to scatter radiation remains significant.<br /><br />In hip preservation surgery, fluoroscopy is crucial for safe access, osseous correction, and alignment. Multiple imaging studies (pre-, intra-, and post-operative) increase cumulative exposure, especially from CT scans, which account for half the dose. A study of 52 patients found average patient exposure of 500 mrem (about 20 chest X-rays) with a very low increase (0.025%) in excess lifetime cancer risk. Surgeons would have to perform about 900 hip arthroscopies annually to reach occupational exposure limits.<br /><br />Higher BMI patients require increased radiation doses for imaging, further elevating exposure to both patient and staff. Eliminating or reducing CT use—via dose-reducing protocols, 3D MRI, or ultrasound—can halve radiation exposure.<br /><br />Conclusions emphasize that OR staff receive sub-threshold but cumulative radiation doses, even at safe distances. Recommended practices include applying the ALARA principle: minimize radiation time and dose, use protective barriers, maintain equipment, optimize positioning, and consider alternative imaging. Reinforcing safety protocols is essential to protect both patients and healthcare workers during hip arthroscopy.

Keywords

Radiation safety

Hip arthroscopy

Occupational exposure

Patient radiation dose

Fluoroscopy

Ionizing radiation

Cancer risk

CT scans

ALARA principle

Orthopedic surgery