To The Editor:
We commend Giordano et al. on their excellent work in quantifying the risk
of radiation when using a mini-C-arm fluoroscopy unit, as reported in their
study entitled "Exposure to Direct and Scatter Radiation with Use of
Mini-C-Arm Fluoroscopy" (2007;89:948-52). Their methodology, however,
does not accommodate for the measurement of increased radiation exposure when
the C-arm is used in the conventional method, with the image intensifier
vertically above the radiation source1. Nor does it estimate what
the exposure dose would be immediately level to the receiver. Their data,
however, remain of value to advance the overall safety of fluoroscopy in
theater.
In our as yet unpublished survey of more than seventy-five orthopaedic
trainees and theater staff in the United Kingdom, we found that the majority
had poor working knowledge of conventional image intensifier usage and
surprisingly little insight into ionizing radiation protection issues.
Although most orthopaedic trainees in the United Kingdom do not "push
the button," they do "guide" the radiographer and supervise
the surgical assistant and theater staff. Therefore, the patient, surgical
teams, and theater staff may be at risk of exposure. With appropriate training
of surgeons, the mini-C-arm may be adopted more widely in the National Health
Service, thereby releasing overburdened radiographers from theater while
increasing throughput and safety in theater, as alluded to by
White2. However, we believe that this can only occur once the
recently disbanded ionizing radiation protection course has been
reinstigated.