Surgical Resident Radiation Knowledge, Attitudes, Practices, and Exposures

Objective

To investigate the level of ionizing radiation exposure among surgical residents and to evaluate resident knowledge, attitudes, and practices regarding exposures.

Design

An observational study was conducted using radiation exposure data for surgical residents who wore film badge dosimeters. A cross-sectional survey was electronically administered at the end of the year, examining resident knowledge, attitudes, and practices concerning radiation exposures.

Setting

Community teaching hospital in the Midwest.

Participants

Surgical residents who wore a badge for the full calendar year and completed study survey. Excluded were graduating chiefs and interns who only had 6 calendar months of data.

Results

A total of 14 surgical residents (100%) were engaged in 168 rotations during study year. Primarily—general surgery (n = 103, 61%), night float (n = 16, 10%), trauma (n = 15, 9%), and vascular (n = 13, 8%). Radiation exposures were greater than a null value during most rotations (i.e., general surgery and night float), with no exposure above occupational thresholds. Certain rotations, namely vascular and trauma, had episodic high exposures. When asked if protective efforts changed during higher-risk rotations, responses revealed they increased (64%) or did not change (36%). A low Cronbach alpha (α = 0.2634) demonstrated that precaution use was not universal and had varied rationale. Percentage of correct radiation knowledge questions was 62%. A multilevel model predicting exposure had a significant multiplicative cross-level interaction term (p < 0.0001) between resident-level exposure and rotation type.

Conclusions

Radiation exposure levels for surgical residents have not been previously investigated. Data demonstrated that surgical residents were not at a greater risk than other medical personnel. However, the study demonstrated detectable radiation exposures that were statistically greater than a null value for the most common rotations. Stochastic and dose-response effects of radiation make any exposure a concern. Attempts to lessen exposures are worthwhile, with study results identifying a need for greater safety precaution education and adherence.

Introduction

Ionizing radiation is a vital and increasingly used tool in medical imaging.¹ Radiation exposure has established deleterious health effects, including increased risk of developing cancer.² It is currently believed that exposure to low levels of ionizing radiation follows a linear dose-response relationship with the development of solid organ cancers. It is also suspected that there is no safe threshold below which radiation exposure does not increase this risk.²

The use of ionizing radiation in medical imaging constitutes a potential risk to patients and medical professionals. Owing to the biological effects of ionizing radiation, the exposure levels and potential repercussions have been investigated.1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 Research studies have described doses of radiation received by a variety of different workers across specialties, especially workers judged to be at the greatest risk, such as anesthesiologists, members of the trauma team, emergency physicians, and orthopedic surgeons.6, 7, 8, 9, 10, 11, 12, 13 A group whose exposure has not been closely examined is general surgery residents. The responsibilities of surgical residents place them in various environments and patient care scenarios involving potential exposure to ionizing radiation. These include the operating suite, where there is repeated use of C-arm fluoroscopy and radiolabeled tracers; trauma resuscitations, in which the members of the trauma team are placed in close proximity to portable radiographic studies and computed tomography scanners; and vascular surgery, with increased exposure from less-invasive surgical treatments. The variability in exposures during these rotations makes surgical residents a unique health care provider with potentially more robust needs for radiation exposure education and awareness.

In the presented study, surgical residents at a community teaching hospital wore film badge dosimeters to monitor radiation exposure for a calendar year and completed a study survey. The aim of the study was to provide descriptive data on surgical resident radiation exposures, as well as to describe resident knowledge, attitudes, and practices regarding radiation exposure and precaution.