Theatre Thyroid Radiation Exposure in trauma and orthopedic surgery - Research Paper Example

? Theatre Thyroid Radiation Exposure in trauma and orthopedic surgery Affiliation Introduction: Duringtrauma surgery of long bones, intra-operative fluoroscopy is frequently used to guide placement of fixation devices. The use of radiation with inconsistent wear of protective thyroid collars highlights the need to measure radiation exposure to the gland. Dose area product (DAP) It is defined as the absorbed dose multiplied by the area irradiated; it is the preferred method of estimation of patient radiation exposure. This is because of its precision due to its independence from variables such as direction of projection. It is considered the gold standard to establish diagnostic reference levels (DRLs) for fluoroscopic procedures Hart et al. 2004 (1), Fitousi et al. 2006 (2). Orthopedic trauma team exposure to occupational radiation is matter of concern which is frequently addressed in the operating theatres. Objectives: The purpose of conducting this study was; To quantify the radiation dose to a surgeon's thyroid during trauma surgery of long bones procedures using mobile image intensifiers. To examine whether the annual dose estimate constraints (The 2007 International Commission on Radiological Protection - ICRP 2007) would be exceeded for a typical workload. Materials and Methods: The complete dosimetric study will be performed at the Royal Preston Hospital. Radiation dose will be measured by thin-layer lithium fluoride thermo luminescence dosimetry (TLD) Chips which carry the advantage of higher precision and minimum interference, due to their small sizes (Anderson, 1999).  We will use four TLD chips. Two trauma surgeons will prospectively each wear two TLD chip in front of their thyroids (under and over the thyroid lead shield) for eight weeks in all cases of trauma surgery using radiation emitted from mobile C-Arms. Records will be kept of the surgeons’ involvement (primary surgeon or assistant), type and number of operations performed, the radiation dose emitted during each procedure (Mosca, 2003). All the radiation calculations will be performed by Joseph Bastin at the North West medical physics department. LTD needs to be assigned to specific personnel and they get dispatched with the names on the chips (Mosca, 2003). Analysis of Data: Trauma surgery of long bones (femur nail and locked femoral nail, tibia nail and locked) also femoral neck fractures needed DHS or cunnulated screws. All Upper limb, foot and spinal surgeries were excluded. The surgeons who are likely to participate in the audit are Mr. Radwane Faroug and Mr. Abdulkhaled Ahmed. Knowledge of long bones enables us to understand the mechanism of their biological functions. The structure of any bone is important to understand different aspects of its functions. Study of the abnormal trauma cell responsible for diseases or inborn errors such as femur nails and locked fermoral nail were further helped by the correlation of trauma surgery. The results of this study also depicted the fact that support surfaces, repositioning the patient, optimizing nutritional status and good care could be the best practices to overcome the chances of surgery (Stamler, 1993). The objective of the study conducted was to review the evidence examining interventions. Various scientists performed a randomized controlled trial with the help of different patients. All these patients were divided into three major sub-groups on the basis of body mass. Such as body mass with above average, below average and average (Stamler, 1993). These were capable to address impairments in mobility, repositioning the patient, optimizing nutritional status and moisturizing sacral limbs for helping the sufferers get rid of the disease. For this, the complexity level of every patient was different and depending upon their complexity, they were treated with different surgical procedures (DHS, Cannulated screw, ORIf Radius and Ulna, femoral nail, Talus fixation and IM tibia) as shown in the table below; Body Mass Date Procedure Complexity Surgeon Above Average 20-Jun-13 DHS Average S1 Above Average 16-Jul-13 DHS Average S1 Above Average 17-May-13 ORIf Radius and Ulna Average S1 Average 22-Jul-13 Cannulated screw Average S1 Average 19-Jul-13 femoral nail Complex S1 Average 5-Aug-13 femoral nail Average S1 Average 7-Jun-13 femoral nail Average S1 Average 1-Jun-13 DHS Average S1 Above Average 3-Aug-13 IM tibia Average S1 Below Average 22-Jul-13 DHS Average S1 Above Average 23-Jul-13 femoral nail Average S1 Below Average 3-Aug-13 DHS Average S1 Child 8-Jun-13 femoral nail Average S2 Average 5-Jul-13 Talus fixation Complex S2 Average 8-Jun-13 IM tibia Average S2 Average 7-Jun-13 femoral nail Average S2 Average 7-Jun-13 Cannulated screw Average S2 Above Average 3-Aug-13 IM tibia Average S2 Below Average 3-Aug-13 DHS Average S2 Discussion: One of the prominent features of these surgical models is the program of circulation rates (relevant to the rate of sounds) and it is especially developed and designed for the same model. When we talk about the child who was treated by S2 surgeon for his femoral nail abnormality, we come to know that these clearly remove compressibility results that are causing the sensitivity in the femoral nail (Evans & Lang, 2004). For the purpose of getting the solution of a discretizing form of all the impacts, incredibly tiny-timed actions were beneficial to resolve the issue of the abnormal blood circulation. The blood of these patients travel at the speeds of audio and sounds. Thus, MRI and CT scan proved to be helpful in observing their surgical changes (Evans & Lang, 2004). Talus fixation initially begins in any part of the body and as time passes it spreads to the human and if not controlled by certain effective medical treatments. There are various forms of Talus fixation that ultimately lead the patient to face surgical problems. Swelling occurs in nearby part of human body where Talus fixation occurs, resulting in an increased intracranial pressure (Mosca, 2003). Femoral nail is the abnormality which could be explained as a step in the sequential process of carcinogenesis. 90% of Femoral nail have an epithelial origin and therefore the understanding of the development of metastasis is inferred from epithelial process. There is a stable alteration in it that results in gradual changes in their phenotype and function. After subsequent changes in function, increased proliferative capacity, cell motility and adhesion, there is a functional and structural imbalance in the cellular microenvironment (Mosca, 2003). These stages are inefficient processes and most of the cells do not survive in conditions of anchorage independence. To produce Femoral nail, cell once held in the sinusoids of the marrow, migrate through the wall and adhere to the extracellular matrix in some endosteal bone surface or periosteum, which is able to stimulate the chances of surgical operations. In many cases, the ability to get stop in a capillary, and finally extravasation and growth in the target organ are not necessary, abnormal cells remain immobilized in a capillary or retained as platelet aggregates so that they can develop a Cannulated screw (Evans & Lang, 2004). Conclusion: Different surgical modifications have been connected with all the stages of trauma and orthopedic surgery. Besides this, the best characterized are the epigenetically mediated transcriptional-silencing events which are associated with the increases in methylation — predominantly at the promoter regions of genes which regulate significant trauma functions (Anderson, 1999). Current evidence shows that the epigenetic alteration might addict cells to the altered signal-transduction trails during the early stages of the growth. Reliance on these consecutive pathways for the cell production or endurance permits them to attain genetic mutations in same pathways, given that the cell with the selective benefits that endorse trauma and orthopedic progression. Strategies to the reverse epigenetic gene silencing may therefore be applicable in this situation to avoid any surgical needs (Evans & Lang, 2004). Reference: 1. International commission Radiological Protection. 1990 Recommendation of the international commission on Radiological Protection. No 60, ICRP 1990; 21 72-9. 2. Doses to Patients from Medical X-ray Examinations in the UK – Hart D, Hillier MC, Wall BF. 2000 Review, NRPB-W14, 2004. 3. Patient and staff dosimetry in vertebroplasty. Fitousi NT, Efstathopoulos EP, Delis HB, Kottou S, Kelekis AD, Panayiotakis GS. 4. Cubas, P, Vincent, C, Coen, E. (1999). An epigenetic mutation responsible for natural variation in floral symmetry. Nature. 401:157-161. 5. Suzuki, M., & Bird, A. (2008). 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