Dose-area product measurements in a range of common orthopaedic procedures and their possible use in establishing local diagnostic reference levels

There is a national drive towards establishing reference doses for radiological procedures with the aim of optimizing patient doses. Furthermore, the establishment of diagnostic reference level doses became a legal requirement for all hospitals on 13 May 2000. However, to date there are little published data on patient radiation doses from fluoroscopic procedures during orthopaedic surgery. Data relating to patient dose for 492 patients undergoing fluoroscopic examinations during a range of surgical orthopaedic procedures in 1997-1998 have been analysed. Median dose-area product (DAP) readings and interquartile ranges for a variety of common fluoroscopic orthopaedic procedures are presented. In general, the median BAP for procedures on limbs and extremities was quite low (0.04-1.62 Gy cm(2)), with screening times in the range 0.2-2.0 min, whilst for procedures involving the hips and spine the median DAP was considerably higher (0.4-10.2 Gy cm(2)), although overall screening times were similar, in the range 0.2-1.4 min. Approximate effective doses have been estimated. For procedures involving the limbs and extremities, the effective dose was generally less than 10 mu Sv, and for procedures involving the hips and spine it was found that the effective dose could rise to about 1 mSv. Collective doses for each procedure have been calculated to inform prioritization of procedures for local dose reduction strategies.