Occupational radiation exposure to anesthetists from fluoroscopic projections during orthopedic operative procedures.

PURPOSE: The role of anesthetists during orthopedic fluoroscopic procedures exposes them to radiation. We conducted a prospective, descriptive study to estimate the radiation exposure to anesthetists during procedures over a six-month period in the orthopedic trauma operating theatres which had the most fluoroscopic usage. MATERIALS AND METHODS: Thermoluminescent dosimeter (TLD) chips were placed two metres away from the radiation source, in three positions to simulate the anesthetist's position in the operating theatre during the fluoroscopic procedures as well as their radiation safety practices. The three positions were above the lead gown, behind the lead gown and behind the protective lead screen. The fourth TLD chip was assigned as a control measure to account for background radiation. The radiation exposure was measured at every end of each month during the period of six consecutive months. The TLD chips were sent to the Malaysian Institute for Nuclear Technology (MINT) for the analysis. RESULTS: From the study, the annual exposure without a protective shield at a 2 metre distance from the projection source was estimated to be 0.70 milliSievert (mSv)/year. With the use of lead gowns and protective lead screens, the annual exposure was estimated to be 0.08 mSv / year. All the radiation levels measured were within the maximum permissible dose of 50 mSv / year. CONCLUSIONS: During fluoroscopic assisted orthopedic procedures, the anesthetists in UKMMC are exposed to a small amount of radiation which is well below the annual maximum permissible limit as determined by local and international regulatory bodies.

Percutaneous transhepatic biliary drainage for obstructive jaundice.

Percutaneous Transhepatic Biliary Drainage (PTBD) is a new but already well-recognised non-surgical method of overcoming extrahepatic biliary obstruction. It can be used as a temporary measure to improve the patient's general condition prior to high-risk operative surgery. It provides time for further investigation and, if the patient has an advanced malignancy, he can be offered a long-term PTBD as the definitive palliative treatment. Thus surgery, with its high rates of mortality and morbidity in such patients, is avoided. In ten cases preoperative PTBD reduced serum bilirubin (P less than 0.01), serum alkaline phosphatase (P less than 0.05), and lactic dehydrogenase (P less than 0.01) levels after 12 +/- 5 days, and resulted in minimal operative morbidity and mortality. Twelve patients with advanced malignancy had long term PTBD and three experienced good palliation for 12-14 months.