Radiation Safety in Orthopaedic Practice

I would employ multiple strategies following ALARA principles: (1) TIME - Minimise screening time, use pulsed fluoroscopy rather than continuous, use last image hold to review images rather than live screening, plan my reduction before screening. (2) DISTANCE - Stand as far from the image intensifier as practical, use the inverse square law (doubling distance quarters dose), use long instruments where possible. (3) SHIELDING - Ensure all staff wear lead aprons and thyroid shields, position mobile lead screens between staff and scatter source. (4) C-ARM POSITION - Keep X-ray tube under the table (away from me) so scatter is directed away, image intensifier toward me. (5) COLLIMATION - Tighten the field to the area of interest to reduce scatter. (6) TECHNIQUE - Use single spot images rather than continuous screening for checks, reduce mA/kVp if image quality permits.

Once pregnancy is declared, the fetus is subject to specific dose limits. ARPANSA recommends a maximum dose of 1 mSv to the fetus for the entire pregnancy. Management: (1) The nurse should inform radiation safety officer and complete a declaration. (2) For this case, she can still participate but should maximise distance from the radiation source and ensure double lead protection (two aprons or wrap-around with additional thyroid protection). (3) Position her away from the primary scatter zone, ideally behind a lead screen. (4) Consider having her step out during intensive screening periods. (5) A dedicated waist-level dosimeter under the apron can monitor fetal dose. (6) Alternative duties could be offered if she prefers, but pregnant workers are not automatically excluded from fluoroscopy cases - it's about implementing additional precautions.

I would explain that scatter radiation is the primary source of staff exposure, and scatter is highest on the X-ray tube side. They should stand on the image intensifier side, or as far from the X-ray tube as practical. I would explain the inverse square law: if they double their distance from the scatter source, their dose reduces to one-quarter. For example, standing 2 metres away instead of 1 metre reduces their dose to 25% of what it would be at 1 metre. Additionally, for lateral views with the X-ray tube beside the patient, they should stand on the opposite side or behind a lead screen. The operator should ideally be positioned so the patient and table are between them and the X-ray tube.