Occupational Health

Topic updated on 08/20/16 5:18pm
Radiation Exposure and Fluoroscopy
  • Factors which increase radiation exposure levels during use of fluoroscopy  
    • imaging large body parts
    • positioning extremity closer to the x-ray source 
    • use of large c-arm rather than mini c-arm
      • radiation exposure is minimal during routine use of mini-c-arm fluoroscopy unless the surgical team is in the direct path of the radiation beam 
  • Factors to decrease radiation exposure to patient and surgeon
    • maximizing the distance between the surgeon and the radiation beam
    • minimizing exposure time
    • manipulating the x-ray beam with collimation
    • orienting the fluoroscopic beam in an inverted position relative to the patient 
    • strategic positioning of the surgeon within the operative field to avoid direct path of beam
    • use of protective shielding during imaging
Risk of Transmission
  • Risk of HIV transmission
    • needlestick  
      • seroconversion from a contaminated needlestick is ~ 0.3% 
        • exposure to large quantities of blood increases risk
      • seroconversion from exposure to HIV contaminated mucous membranes is ~0.09%
    • frozen bone allograft
      • risk of transmission is <1 per million
        • donor screening is the most important factor in prevention
        • no reported cases of transmission from frozen bone allograft since 2001
    • blood transfusion
      • risk of transmission from blood transfusion is 1/500,000 per unit transfused
      • seronegative blood may still transmit virus due to delay between HIV infection and antibody development
  • Risk of Hepatitis B transmission
    • needlestick
      • 37% to 62% eventually seroconvert following needlestick
      • 22 to 31% develop clinical Hepatitis B infection following needlestick
  • Risk of Hepatitis C transmission
    • needlestick
      • 0.5 to 1.8% risk of transmission
Resident Surgeon Work Duty Hours
  • ACGME has restricted work hours in order to address impaired performance by residents caused by long duty hours
  • Duty hours 
    • include
      • clinical time
      • academic hours
      • administrative work  
      • time on call
        • no more than 1 day per every 3 days in house 
        • must include a 10-hour period of  "off-time" between
          • clinics
          • on-call  
    • restricted to 80 or less per week (averaged over a 4 week period)
    • 10% increase allowed if justified by educational value
    • 1 day in 7 must be a day off (averaged over 4 week period)
  • Results of new duty hours
    • early evaluations have caused concern over issues of 
      • patient safety 
      • continuity of care
        • communication and transfers in care have been cited as sources of decreased continuity of care as a sequelae of the 80-hour resident physician work week  


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Qbank (4 Questions)

(OBQ10.95) When using C-arm fluorocopy, patient radiation exposure will be increased with which of the following? Topic Review Topic

1. The extremity is positioned closer to the image intensifier
2. A larger body part is imaged compared to a smaller body part
3. Use of radiation beam collimation
4. Mini C-arm fluroscopy is used instead of large C-arm fluroscopy
5. Decreased duration of imaging

(OBQ10.179) Which of the following configurations creates the least radiation exposure for the operative surgeon during upper extremity surgery? Topic Review Topic

1. Imaging the thumb positioned against the x-ray source with the standard C-arm
2. Imaging the wrist positioned against the x-ray source with the standard C-arm
3. Imaging the thumb positioned against the image intensifier with the mini C-arm
4. Imaging the wrist positioned against the image intensifier with the mini C-arm
5. Imaging the thumb positioned against the x-ray source with the mini C-arm

(OBQ09.88) All of the following are cited as a concern for decreased continuity of care when "signing out" patient care from one provider to another EXCEPT? Topic Review Topic

1. Omitting the patients' current clinical condition
2. Omitting guidance for events likely to occur on the next shift
3. Signing out to physician extenders instead of a resident physician
4. Rationale not given for plans provided to the covering physician
5. Tasks not assigned to the covering physician for completion

(OBQ06.3) An orthopaedic surgeon is closing a total knee replacement incision of a patient with HIV and accidently sustains a needlestick. What is the surgeon's approximate risk of contracting the virus? Topic Review Topic

1. 0.3%
2. 3%
3. 10%
4. 20%
5. 30%



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