XRay in the OR

[ulikedaggers]

Advertisement - Members don't see this ad

I was in an orthopaedic OR recently and they were doing Xrays throughout to make sure pins, screws, etc were placed properly. Nobody was wearing a lead vest or anything like that.

Is this normal?

 

[SouthernSurgeon]

I was in an orthopaedic OR recently and they were doing Xrays throughout to make sure pins, screws, etc were placed properly. Nobody was wearing a lead vest or anything like that.

Is this normal?

No.

Every OR I've ever been in people are pretty diligent about lead protection, especially for fluoro or cases where you are going to be taking a lot of shots.

 

[ulikedaggers]

No.

Every OR I've ever been in people are pretty diligent about lead protection, especially for fluoro or cases where you are going to be taking a lot of shots.

Well that's good to know. Thanks.

 

[Winged Scapula]

I was in an orthopaedic OR recently and they were doing Xrays throughout to make sure pins, screws, etc were placed properly. Nobody was wearing a lead vest or anything like that.

Is this normal?

That's pretty unusual. Are you sure they weren't wearing lead under their gowns or standing behind a shield?

 

[ulikedaggers]

That's pretty unusual. Are you sure they weren't wearing lead under their gowns or standing behind a shield?

Yup, I was scrubbed in and standing alongside the case. The surgeons were only wearing scrubs and it didn't seem like anything unusual was bulging out from under them (like a lead vest). Also I rounded with them afterwards and they went directly from OR to the ward so if they were wearing anything under their scrubs then they rounded with it on too (which I think is unlikely).

They were using something that looked like this.. Possible that it has a built in shield or something? No idea how this stuff usually works.

 

[Lavan]

If they're standing far away they'll minimize dose, but no, they're supposed to wear lead. Even when radiology equipment has leaded glass shields etc, you still need lead because most of your dose comes from scatter radiation not the tube itself.

 

[ulikedaggers]

If they're standing far away they'll minimize dose, but no, they're supposed to wear lead. Even when radiology equipment has leaded glass shields etc, you still need lead because most of your dose comes from scatter radiation not the tube itself.

Oh no, they were basically right up against it.. as was I. I'll be more aware of it when I'm in the OR everyday during the clerkship. Thank you.

 

[tco]

Yup, I was scrubbed in and standing alongside the case. The surgeons were only wearing scrubs and it didn't seem like anything unusual was bulging out from under them (like a lead vest). Also I rounded with them afterwards and they went directly from OR to the ward so if they were wearing anything under their scrubs then they rounded with it on too (which I think is unlikely).

They were using something that looked like this.. Possible that it has a built in shield or something? No idea how this stuff usually works.

Were you with them every second? The lead isn't really bulky, so you probably wouldn't be able to tell unless you saw it when they degowned. It would be right under the gown, between the scrubs and the gown...I find it really hard to believe a surgeon would do this. Especially an orthopod that uses it a lot.

 

[Beargryllz]

That isn't normal. Here, they wheel in a whole wardrobe of lead vests for people of all shapes and sizes before the radiation starts going

 

[ulikedaggers]

Were you with them every second? The lead isn't really bulky, so you probably wouldn't be able to tell unless you saw it when they degowned. It would be right under the gown, between the scrubs and the gown...I find it really hard to believe a surgeon would do this. Especially an orthopod that uses it a lot.

Yes, every second. And there were no gowns. One Attending and one R3.

 

[tco]

Yes, every second. And there were no gowns. One Attending and one R3.

One R3? Like third year rads resident? I'm calling troll.

Sent from my SCH-I535 using Tapatalk

 

[SouthernSurgeon]

One R3? Like third year rads resident? I'm calling troll.

Sent from my SCH-I535 using Tapatalk

Some places just call residents R-whatever. Presumably he meant a third year ortho resident

 

[ulikedaggers]

One R3? Like third year rads resident? I'm calling troll.

Sent from my SCH-I535 using Tapatalk

No, I meant a third year ortho resident. Sorry, I didn't know "R" meant only radiology residents.

Also, there were no gowns because it wasn't a particularly messy surgery.

 

[MerickManual]

Sounds like a really dodgy place. Lead up!

 

[username456789]

Sorry, I didn't know "R" meant only radiology residents.

It doesn't.

 

[Winged Scapula]

Yup, I was scrubbed in and standing alongside the case. The surgeons were only wearing scrubs and it didn't seem like anything unusual was bulging out from under them (like a lead vest). Also I rounded with them afterwards and they went directly from OR to the ward so if they were wearing anything under their scrubs then they rounded with it on too (which I think is unlikely).

They were using something that looked like this.. Possible that it has a built in shield or something? No idea how this stuff usually works.

That's a fluro machine and C arm. Lead should have been used. As in radiation safety/hospital policy/I'd like to keep my thyroid and genitals intact required.

No, I meant a third year ortho resident. Sorry, I didn't know "R" meant only radiology residents.

Also, there were no gowns because it wasn't a particularly messy surgery.

Wait. Didn't you say this was an Ortho case? 😉

 

[ulikedaggers]

That's a fluro machine and C arm. Lead should have been used. As in radiation safety/hospital policy/I'd like to keep my thyroid and genitals intact required.




Wait. Didn't you say this was an Ortho case? 😉

Yeah, it was just a MTP fusion. I imagine most other ortho cases are a tad more messy 🙂

 

[SouthernSurgeon]

Yeah, it was just a MTP fusion. I imagine most other ortho cases are a tad more messy 🙂

So...I really have a number of questions here.

At first when you said there were no gowns, I was assuming this was like a closed reduction and pinning under fluoro. But unless I'm missing something (not an orthopod) a joint fusion is an open case.

The purpose of a gown is not to protect you from mess (well, that's a secondary purpose). It's part of maintaining a sterile technique and minimizing the risk of contaminating an open wound.

It's very hard to believe that there is a hospital out there were orthopods are doing open surgery without gowning up.

 

[ulikedaggers]

So...I really have a number of questions here.

At first when you said there were no gowns, I was assuming this was like a closed reduction and pinning under fluoro. But unless I'm missing something (not an orthopod) a joint fusion is an open case.

The purpose of a gown is not to protect you from mess (well, that's a secondary purpose). It's part of maintaining a sterile technique and minimizing the risk of contaminating an open wound.

It's very hard to believe that there is a hospital out there were orthopods are doing open surgery without gowning up.

Sorry, there were gowns. I'm not sure what I was thinking before... Anyway, I watched the scrubs gown/glove both the attending and the resident and neither of them were wearing anything over their scrubs. Now this looks even more like a troll thread.

Let's say I did miss something and the resident/attending were both wearing some kind of radiation protection. What's the likelihood that they would continue wearing it while rounding?

I was going to ask you guys how likely it is that the scrub/circulator would let a med student not have a vest or something on, but I guess they might not care.

 

[Mad Jack]

Alright, I've got to ask. In my hospital, when they roll in a portable X ray machine, they say you're fine as long as you're six feet away due to the small dose used etc. I always step out of the room anyway when possible, but was wondering if this was at all legit or if there was any research to back it up. We get site visits all the time, and daily CXRs are pretty routine on many of our patients, so I would imagine if this was a hazard somebody would have spoke up by now....

 

[SouthernSurgeon]

Alright, I've got to ask. In my hospital, when they roll in a portable X ray machine, they say you're fine as long as you're six feet away due to the small dose used etc. I always step out of the room anyway when possible, but was wondering if this was at all legit or if there was any research to back it up. We get site visits all the time, and daily CXRs are pretty routine on many of our patients, so I would imagine if this was a hazard somebody would have spoke up by now....

Radiation exposure decreases exponentially with distance. Six or so feet away is generally the tipping point I've heard quoted.

The issue here is that we are talking about continuous radiation exposure (fluoroscopy) - which is much higher radiation dosing than single shot x-rays.

Here is an article on radiation exposure in orthopedics:http://www.ncbi.nlm.nih.gov/pubmed/9314144

 

[Mad Jack]

Radiation exposure decreases exponentially with distance. Six or so feet away is generally the tipping point I've heard quoted.

The issue here is that we are talking about continuous radiation exposure (fluoroscopy) - which is much higher radiation dosing than single shot x-rays.

Here is an article on radiation exposure in orthopedics:http://www.ncbi.nlm.nih.gov/pubmed/9314144

Thanks!

Didn't realize op was talking about fluoro. Doing that without lead is basically just asking for cancer, wow...

 

[Winged Scapula]

Sorry, there were gowns. I'm not sure what I was thinking before... Anyway, I watched the scrubs gown/glove both the attending and the resident and neither of them were wearing anything over their scrubs. Now this looks even more like a troll thread.

Yes but trolls usually never admit it, so you're ahead of the game.

Let's say I did miss something and the resident/attending were both wearing some kind of radiation protection. What's the likelihood that they would continue wearing it while rounding?

None.

I was going to ask you guys how likely it is that the scrub/circulator would let a med student not have a vest or something on, but I guess they might not care.

They should care but they might not. Fluoro is high risk/high exposure. Perhaps if their surgeons are so cavalier as to not wear lead then the OR staff thinks the risk to them (and you) is minimal. It is not. At the risk of being the only one, if you're in there again, please wear lead.

 

[ulikedaggers]

What is Fluoro?

Sorry if the picture I put up there is misleading. The machine they were using looked like that one, but I haven't been in many ORs, so maybe there are several machines that look similar.. Anyway, what they were doing was stepping on a pedal each time they wanted to check if the pin was in the right position. They probably took 5-10 images the whole time.

 

[DrBowtie]

What is Fluoro?

Sorry if the picture I put up there is misleading. The machine they were using looked like that one, but I haven't been in many ORs, so maybe there are several machines that look similar.. Anyway, what they were doing was stepping on a pedal each time they wanted to check if the pin was in the right position. They probably took 5-10 images the whole time.

Is there a possibility they used the drop away lead? There is lead that has Velcro that can be released through the gown and drops to the floor. Good for cases where fluoro is used in the beginning then not needed later such as ports.

 

[Kaustikos]

My place asks us to. We don't have to if we don't want to, but we get ridiculed for it. The nurses are particularly funny about dashing out the infertility jokes if you don't. But they always ask/remind us so we can either step out or get a vest. If we can't get to one, we stand behind the person wearing one like a shield. I've had one or two instances where I just stood behind the xray tech because I was scrubbed and forgot to get my vest.

Also, pro-tip, make sure the vest covers your pelvis, too. Some vests are three-piece and you might only grab the center and forget that it doesn't cover your genitals. I did that... and had the hilarity of having a nurse put on the lower part on me. Insert EVERY joke you've heard about the nurse that has to get the pager from the surgeon in the OR who has it on his pants and not on the desk.

But truth be told - I'm sure that if I decided NOT to wear one for one case, I'd probably never get invited to cases ever again.

 

[Kaustikos]

Also - this far into the thread and NO ONE's made a joke about orthopods and this situation?

 

[evilbooyaa]

Really abnormal situation. To answer your question, fluoro is (from my limited exposure to it) a continuous x-ray that allows for immediate visualization. It's generally triggered by a foot pedal and can either be used to check for placement (like pins in ortho in your case) or for dye movement (like vascular surg in my case).

Like WS said, ask for lead in the next case. It's irresponsible to not be wearing lead in the same room as a C-arm.

 

[ulikedaggers]

Is there a possibility they used the drop away lead? There is lead that has Velcro that can be released through the gown and drops to the floor. Good for cases where fluoro is used in the beginning then not needed later such as ports.

Could be.. I've never heard of that so if it was there I probably wouldn't have noticed it.

 

[Wordead]

My older surgeons said they didn't wear them because "they weren't long for this world anyway" but I was free to put on lead.

 

[Winged Scapula]

Also - this far into the thread and NO ONE's made a joke about orthopods and this situation?

I did - see above about blood loss.

 

[Kaustikos]

I did - see above about blood loss.

Oh, oops. Have I ever talked about how I can't read? 😆

 

[Armadillos]

I've seen orthos be super casual with the C-arm in the ED before, they were setting an arm and the way the resident had himself positioned his crotch was basically inches away from the beam (not wearing lead).

 

[Rendar5]

still bad form. It never crossed my mind NOT to use lead with fluoro, it's second nature to slip it on. And this is coming from an ED attending who'll take an occasional x-ray dose to keep someone in position for my techs.. Only time I even get near fluoro is if I'm assisting a closed reduction in the ED, or fishing an insulin syringe needle tip out of a IVDAer's arm (aka once in a blue moon)

 

[SouthernSurgeon]

still bad form. It never crossed my mind NOT to use lead with fluoro, it's second nature to slip it on. And this is coming from an ED attending who'll take an occasional x-ray dose to keep someone in position for my techs.. Only time I even get near fluoro is if I'm assisting a closed reduction in the ED, or fishing an insulin syringe needle tip out of a IVDAer's arm (aka once in a blue moon)

Yeah, I mean we've all gotten hit with the random single shot x-ray every now and then. But I thought pretty much all docs had a pretty healthy paranoia about fluoroscopy...

 

[JJMrK]

Yeah, it was just a MTP fusion. I imagine most other ortho cases are a tad more messy 🙂

Surprised no one has mentioned this, but that's a pretty small extremity case. Was it a mini c? It's more common to operate without lead while using those as the scatter and exposure to the surgeon are thought to be much lower (although interestingly, patient exposure may go up; PMIDs if you care: 21276563 and 21414730).

 

[ulikedaggers]

Surprised no one has mentioned this, but that's a pretty small extremity case. Was it a mini c? It's more common to operate without lead while using those as the scatter and exposure to the surgeon is thought to be much lower (although interestingly, patient exposure may go up; PMIDs if you care: 21276563 and 21414730).

I'm not really sure since I've never been in any other ORs, but it was about the same size as this one.. So yes I guess it was a mini C arm.

 

[JJMrK]

Yep, that's a mini. Prob explains why nobody had lead on.