Image-guided reconstruction of femoral fractures: is the staff progeny safe?

The potential of adverse effects to progeny caused by preconceptual and fetal exposure to ionizing radiation is an issue of increasing concern to orthopaedic surgeons and assisting staff. Are these fears justified? How effectively is the embryo or fetus protected, and should pregnant staff alter their duties? In this study, an anthropomorphic phantom was exposed fluoroscopically at two geometries common in surgical reconstruction of proximal femur fractures. Scatter radiation was converted to gonadal dose and embryo or fetal dose with and without use of a protective apron. The genetic risk for the orthopaedic surgeon after 10 years of occupational exposure was estimated to be 16,000 times lower than the natural frequency of heritable disease. The excess risk of childhood cancer associated with the dose accumulated during gestation was at least 600 times lower than the corresponding natural frequency. A properly shielded pregnant orthopaedic surgeon is allowed to do 14 hours of hip fluoroscopy during gestation, whereas 2100 hours of fluoroscopy are required for the induction of gross malformation or mental retardation to the growing embryo or fetus. The supplementary dose constraints for pregnant staff provide adequate protection to the unborn child without affecting regular personnel duties.