Marie Curie, a brilliant physicist, was the first female to win the Nobel prize for her pioneering work on radioactivity. She is a role model for her groundbreaking contributions to science. It’s ironic that the same research that brought her such well-earned recognition eventually led to her demise: aplastic anemia secondary to radiation exposure.

Adverse events associated with radiation include deterministic (e.g., hair loss, skin burns, nausea, cataracts) and stochastic (i.e., carcinogenesis, teratogenesis) effects. As orthopaedic surgeons, we also continually expose our bodies to radiation in our quest for success and best outcomes.

Risks of radiation

Low-dose ionizing radiation—such as the kind we encounter every day in the operating room with fluoroscopy—has been shown to increase the risk of breast cancer with long-term exposure. A cross-sectional study conducted at Stanford University found that due to the radiation exposure inherent in orthopaedic practice, especially in spine and trauma subspecialties, the prevalence of cancer was 85 percent higher in female orthopaedic surgeons than in the general U.S. population. Furthermore, the prevalence of breast cancer was 2.9-fold higher in female orthopaedic surgeons compared to the general U.S. female population. Based on their comparison of breast cancer rates among female surgeons in urology, plastic surgery, and orthopaedic surgery, the researchers found that the increased breast cancer risk was unique to orthopaedics.

In addition, many people don’t realize radiation’s effects on pregnancy. Female orthopaedic surgeons have a significantly higher risk of complications during pregnancy (31.2 percent) than the general U.S. population (14.5 percent). The odds of preterm labor and delivery are 4.95 times higher in female surgeons who work more than 60 hours per week. These facts call for a more robust discussion on this topic in the orthopaedic community at large.

Courtesy of julie balch samora, md, phd

Raising awareness

Perhaps radiation alone cannot be blamed for these complications. Conceivably, the true enemy may be our own ignorance of its power.

For example, a study performed to assess orthopaedic surgeons’ knowledge about radiation exposure found that of the approximately 1,000 participants, only nine knew the amount of radiation dose received with standard anteroposterior imaging. Furthermore, 99.2 percent had no idea about the amount of radiation a patient is exposed to during fluoroscopy, and only 8.7 percent had actually read an article about fluoroscopy. However, most disturbing was that only 85 percent of the study participants used lead aprons for protection on a regular basis, and just 70 percent used thyroid shields.

Proper shielding is of utmost importance. Because we’re taught that exposure is inversely proportional to the square of the distance from the source, we are all guilty, at times, of forgoing use of the lead apron and/or thyroid shield when using the mini-fluoroscopy unit or even the larger C-arm. We stand a few feet away from the C-arm and consider ourselves “safe.” But are we really? Only time will tell if the process of oncogenesis has already begun.

Radiation is a foe that cannot be seen, felt, smelled, or heard. It’s hard to fight this “invisible enemy.” But’s that exactly what we must do, using the only weapons at our disposal—education, awareness, proper positioning, and lead.

Sravya Vajapey, MD, is an orthopaedic resident at Ohio State University. She is also concurrently pursuing an MBA at Fisher College of Business in Columbus, Ohio. She can be reached at sravya.vajapey@osumc.edu.

Julie Balch Samora, MD, PhD, is a pediatric hand surgeon at Nationwide Children’s Hospital in Columbus, Ohio. She is the director of quality improvement for the Department of Orthopaedics. She can be reached at julie.samora@nationwidechildrens.org.

References

1. Caird M: Radiation safety in pediatric orthopaedics. J Pediatr Orthop. 2015;35:s34-s36.
2. Chou LB, Chandran S, Harris AH, et al: Increased breast cancer prevalence among female orthopedic surgeons. J Women’s Health (Larchmt). 2012;21:683-689.
3. Chou LB, Lerner LB, Harris AH, et al: Cancer prevalence among a cross-sectional survey of female orthopedic, urology, and plastic surgeons in the United States. Women’s Health Issues. 2015;25:476-481.
4. Hamilton AR, Tyson MD Braga JK, et al: Childbearing and pregnancy characteristics of female orthopedic surgeons. J Bone Joint Surg Am. 2012;94:e77.
5. Tuncer N, Kuyucu E, Sayar S, et al: Orthopedic surgeons’ knowledge regarding risk of radiation exposure: a survey analysis. SICOT J. 2017;3:29.