• thyroid
• shield
• neoplasia
• x-ray
• orthopaedic

The sensitivity of the thyroid to radiation is well documented, and a preliminary study¹ suggested an increased incidence of thyroid cancer in Australian orthopaedic surgeons. We have conducted a survey to assess the availability and use of thyroid shields by orthopaedic surgical trainees in the UK.

As most x ray radiation exposure to the surgeon occurs during surgery for trauma, 50 hospitals with acute orthopaedic services were studied. The survey was conducted by telephone and post. The orthopaedic registrar on-call was asked if a thyroid protective lead shield was available to them when operating with image intensifier, and if they routinely used the shield. If the registar reported that shields were not available, then the hospital’s superintendent radiographer was asked if shields were available to the surgeons.

At the 50 hospitals studied, the registrar at 20 hospitals reported that thyroid shields were available. At the other 30 hospitals, the radiographers at eight hospitals confirmed that shields were indeed not available. At the 20 hospitals where the registrars knew shields to be available, only seven registrars used the shield routinely.

A study by Dewey and Incoll,² in which orthopaedic trainees followed their usual radiation protection practice and wore a radiation monitor for a three month period while operating, revealed that 50% wore thyroid shields, and that the exposure ranged from 0.01 to 0.4 mSv. This exceeded the dose limits for the general population in two trainees, but all were within current occupational exposure guidelines. Their data also showed that the dose had a close relationship with the number of emergency operations performed. We have also observed a tendency for the more junior surgeons to get closer to the operation site and more directly into the line of the image intensifier.

Our simple study of hospitals in the UK with acute orthopaedic services has shown a low usage of thyroid protection shields by orthopaedic registrars. Only 14% of registrars surveyed use these protective shields routinely when operating with image intensification equipment. The results indicate that a large proportion of registrars do not use shielding although it is available to them. This implies both a rather casual approach to reducing personal occupational risk, and ignorance of the availability or otherwise of thyroid shields.

Our results also show that 16% of hospitals do not provide thyroid protection shields for use by the surgeon. In some hospitals where thyroid shields are available they may not be readily so. We could not assess the level of this accessibility in our study.

The provision and use of protective shields may be viewed as significant health and safety issues. The evidence is that irradiation of the thyroid region should be minimised. Perhaps all hospitals should furnish adequate protective shielding and render it a requirement that they be used all surgeons undertaking procedures with image intensifier.