The evolution of more rational educational programs and other societal changes point to a future where an increasing number of orthopaedic surgeons will be female. Thankfully, we have made gains in adjusting the medical community’s perspective on careers in orthopaedic surgery. No longer are we perceived to be “stronger than a mule and twice as smart” or merely “buckles and braces men.” Evolving interventional techniques that rarely require brute force have also helped change this view.
At the same time, with the rapidly increasing need for musculoskeletal care as the population ages, we need every orthopaedic practitioner—male and female—to remain as healthy and active as possible. Epidemiologic studies of surgeon health have revealed real concerns for neck and back degenerative changes and cancer risk.
In the November 2, 2016 edition of The Journal, Valone et al. tackle the issue of exposure of the female breast to intraoperative radiation. In a nifty study incorporating C-arm fluoroscopy and an anthropomorphic torso phantom equipped with breast attachments and dosimeters, the authors found that:
- The median dose-equivalent rate of scatter radiation to the breast’s upper outer quadrant (UOQ) was higher than that to the lower inner quadrant.
- C-arm cross-table lateral projection was associated with higher breast radiation exposure than anteroposterior projection.
- Size, fit, and breast coverage of lead protection matter.
The findings should prompt redesign of protective aprons and vests to more effectively cover the breast and axilla. We could also use more well-designed longitudinal studies to identify the risk factors for neck, back, and shoulder injury as well as gain a better understanding of the real risk of surgeon exposure to intraoperative radiation.
Annual occupational radiation dose limits to the breast have not yet been established. But in the meantime, Valone et al. recommend distancing the axilla from the C-arm and placing the X-ray source beneath the operating table or on the contralateral side to reduce radiation exposure to the UOQ of the breast.
Marc Swiontkowski, MD
JBJS Editor-in-Chief
