The shield multicentre collaborative: A study of hand surgeons' intraoperative radiation exposure and techniques to limit dosing.

Purpose: Fluoroscopic radiographic imaging is indispensable in modern hand surgery. Challenges in positioning patient digits during complex hand injury assessments can result in direct radiation exposure to operating staff. The adverse health risks associated with radiation exposure, including malignancy, are well documented and demand clear risk reduction strategies. The EURATOM 2013/59 directive provides guidance on reducing occupational exposure under the 'as low as reasonably achievable' (ALARA) principle. This study aims to assess the prevalence of non-patient (surgeon) anatomy in intra-operative radiographs and outline prevention strategies to optimise radiation safety practices for hand surgeons. Methods: A national multi-centre audit of direct occupational hand surgeon radiation exposure was performed. Intra-operative radiographic images obtained during hand surgery cases across six plastic and reconstructive surgery centres were retrospectively reviewed. The primary outcome was the presence of non-patient (surgeon) anatomy in intra-operative radiographic images. Secondary outcomes include timing of surgery (working hours vs. out-of-hours), procedure type and surgeon seniority (consultant vs. trainee). Results: A total of 852 hand trauma procedures performed across the six national centres across a three-year period were included. Non-patient digits were present in intra-operative radiographs in 51.7 % of cases (range, 22.3-78.3 %). The most common procedure was fracture reduction and k-wire fixation (n = 515, 60.4 %). There was significant variance between the surgical units in the rate of non-patient anatomy captured, indicating inter-hospital differences in radiation safety practice adherence. Twenty-two percent of procedures were performed out-of-hours. There was no significant relationship between radiation exposure and procedure timing or surgeon seniority. Conclusions: Hand surgeons are frequently exposed to excess intra-operative radiation. Radiation safety training, strict adherence to intra-operative radiation safety protocol, formal radiation safety education, and use of innovative surgical equipment, may help reduce the rates of radiation exposure in hand surgery. Type of study: Differential diagnosis/symptom prevalence study. Level of evidence: 2c.