Underestimation of fluoroscopic exposure among orthopedic residents

Concerns about radiation exposure for health care workers have increased in the last decade, along with the increased use of fluoroscopic imaging for surgical procedures. Recent literature suggests that surgeons with the least experience have higher exposure during surgery, and their perception of exposure may be lower. The purpose of this study was to examine the accuracy of orthopedic resident trainees' estimates of their exposure during fluoroscopy cases. Orthopedic resident trainees were surveyed after participation in various fluoroscopic orthopedic surgeries and asked to estimate the number of fluoroscopy exposures used. Their answers were compared against the actual number of exposures retrieved from the fluoroscopy machine. The perceived number of exposures was then compared to the actual number taken for junior residents in training year 1, 2, or 3 versus senior residents in training year 4 or 5. Nineteen residents were surveyed, 13 of which were junior residents and six of which were senior residents. Of the 13 junior-level residents, total estimation was 441 exposures, versus 1411 actual exposures, an underestimation of over 69%. The six senior residents totaled 457 estimated exposures, compared to 645 actual exposures, for an underestimation of just under 30%. In this survey study at a single institution, junior-level residents greatly underestimated radiation exposure compared to senior-level residents. Trainees should be aware that they grossly underestimate their exposure levels during procedures, and residency programs should emphasize fluoroscopic training early.