To The Editor:
We read with much interest the recent article "Patient and Surgeon Radiation Exposure: Comparison of Standard and Mini-C-Arm Fluoroscopy" (2009;91:297-304) by Giordano et al. It addressed an important issue arising from the increasing use of radiographic imaging in medicine. Although the authors correctly concluded that protective safety measures should be enforced when using intraoperative fluoroscopy, it might be useful to the reader to have a more complete understanding about the magnitude of these radiation doses.
The authors recognized that the radiation received during fluoroscopy was very low compared with the dose of radiation that can cause deterministic (hair loss or burns) or stochastic effects (carcinogenesis or genetic effects). At first look, the dose received by the patient in the worst-case scenario seems to be very high, but one must consider that while the amount of radiation is an important parameter in determining the associated risk, the radiosensitivity of the exposed tissues is important as well. For example, muscle and bone are the least radiosensitive tissues in the human body1.
For a surgeon operating in the standing position, a dose of 0.38 mGy could reach the gonads, the most radiosensitive organs in the body, and generate a more harmful effect than a dose of 90 mGy delivered to the foot or hand of a patient. The resulting radiation doses from this study are approximately 6600 times less and five times less, respectively, than the threshold dose for tissue effects in gonads and bone marrow (2.5 Gy and 0.5 Gy)1.
While safety precautions should be in place in the operating room, one must not overestimate the adverse effects associated with the use of fluoroscopy. An assessment by the authors of the lifetime attributable risk of cancer or mortality associated with the consistent use of fluoroscopy would have provided a more realistic understanding about the potential associated risks.