Optimizing radiation safety in surgery

While simple routine surgery is commonly based only on preoperative imaging, for complex interventions intraoperative imaging may provide useful guidance and is more and more used in equine practice. Intraoperative imaging is based on a multitude of imaging modalities. The most commonly used are intraoperative radiography, fluoroscopy-guidance and ultrasound-guidance. CT assisted surgery has been more recently developed. Except ultrasoundguidance all the quoted imaging modalities use ionizing radiations and it is therefore essential to promote radiation safety for surgeons and surgery room personnel in general. In comparison to promote radiation safety for radiologists and radiology technicians, promoting radiation safety culture in groups of professionals not daily confronted to radiation exposure is more challenging. It is in fact known that there is a potential misinterpretation of the acceptance of this “occasional” occupational risk as being “necessary to obtain the results” and in some cases even being a symbol of professionalism and commitment. In this context, the first step to introduce and strengthen a radiation safety culture is to increase knowledge about basic principles in radiation safety and give recommendations to optimize conditions of use of radiating modalities in the surgery room. Radiation safety is always based on the application of 3 principles: justification, optimization and limitation. To correctly apply the principle of justification it is essential knowing the risk and have some radiobiology knowledge. Justification should obviously always be applied prior to optimization. For optimization first of all the equipment should be operating properly and be periodically tested. Type of the equipment has also an impact because of the amount of emitted radiation can change. The situation in the equine surgery room is different in comparison to human medicine because of size and position of the patient. In human medicine it is known that, in comparison to vertical irradiation, oblique projections increase radiation by a factor of 5. [...]