Radiation to Patients during Dynamic Hip Screw Surgery

Objective: The aim of this study was two fold. To determine the diagnostic reference level (D.R.L.) dose of radiation during dynamic hip screw (D.H.S.) fixation and, to audit the orthopaedic department against this standard. Methods and Materials: A retrospective analysis of 112 consecutive patients between 31st December 2002 and the 6th July 2003, at Darenth Valley Hospital, Dartford, under going dynamic hip screw fixation for proximal femur fractures was carried out. The data was collected from the Radiographers log. The screening time and Dose Area Product (DAP) for each event was analyzed in conjunction with the Radiation Protection Department at Kings College, London. Taking the 75th percentile from the existing data, the DAP was set at 1.05cGy/cm2. The screening time for the procedure was set at 64.2 seconds. An audit to access the performance of the orthopaedic department against these standards was carried out. All grades of surgeons performing this procedure were included in the audit. Results: In the total of 112 patients, there were 32 males and 80 females. The age range was from 27 to 99 years with a mean of 83.96 years. Sixty fractures were on the right side and 52 on the left. The total screening time for the procedures was 78.25 minutes with an average of 0.877 of a minute (i.e.) 52.62 seconds. The total Dose Area Product (DAP) was 96.42cGy/cm2 with an average of 0.860cGy/cm2. Conclusion: At present there are no DRL for orthopedic procedures locally or nationally in the United Kingdom, despite this being a legal requirement since May 2000. The authors have determined a local DRL for DHS fixation which can be used as a guideline for this procedure. We recommend that DRL be set for other orthopedic procedures done under Fluoroscopic guidance, especially procedure involving younger patient.