tained. Hang — never fold — them in storage. Visually inspect
aprons regularly for cracks or tears.
The weight of lead aprons can be a strain, especially to those
who work many cases or have back injuries. Consider two-piece
aprons, aprons designed to distribute weight to the shoulder flaps
or newer lead-free lightweight options that offer comparable pro-
tection to 0.5-mm lead equivalent aprons.
Keep your hands out of the line of radiation when X-rays are
being taken. There have been reports of sarcomas of the hand
developing in surgeons who are repeatedly exposed. A new bis-
muth-oxide-based hand cream reportedly decreases radiation
exposure for those who must keep their hands in the imaging
field during procedures — trauma surgeons holding bones togeth-
er, for example. I've tried the cream, but didn't enjoy the feeling of
working with the layer under my gloves. Surgical team members
might instead opt for lead-lined gloves or, if possible, focus on
removing their hands from the field when the X-ray is activated.
In orthopedics, we roll in moveable lead-lined shields that ancillary
staff stand behind when the fluoroscopy is shot. All those present
during imaging should wear dosimeter badges. The annual safe
thresholds of exposure are 20 mSv for the eye lens, 500 mSv for the
skin and 500 mSv for the hands and feet, per ICRP. Monitor the
badges monthly or bimonthly — whatever duration the dosimeter
manufacturer suggests — to ensure they remain within the safe
threshold of exposure.
OSM
8 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 1 6
Dr. Waddell (brad.waddell1@gmail.com) is a fellow of joint reconstruction at
the Hospital for Special Surgery in New York, N.Y.
