OR radiation is a top 10 technology hazard
ECRI urges broader radiation monitoring
The rapid growth of image-guided surgery has revolutionized procedures and reduced recovery time for patients, but it has increased risks of radiation exposure to the operating room staff.
To alert hospitals of this emerging hazard, ECRI Institute, an independent health care research firm based in Plymouth Meeting, PA, has included radiation in "hybrid" ORs as one of the nation's top 10 health technology hazards for 2014.
The concern arises because radiation use in the operating room has become much more common with the use of advanced imaging systems to guide surgery. "Suddenly, you're introducing a technology that has the potential to deliver a much higher dose than has previously been the case in the OR," says Jason Launders, MSc, director of operations for ECRI's Health Devices Group.
Traditionally, radiation safety officers monitor radiation exposure in radiology departments by assigning badges to the affected employees. Those badges are collected regularly, such as monthly, to monitor employees' cumulative dose. The goal is to keep the dose as low as reasonably achievable.
Yet broader uses of radiation throughout the hospital, it has become more difficult to track employee exposures, says Launders. "There is an opportunity here to reexamine your radiation safety program and make sure you are doing what is necessary to keep your staff safe," he says.
By highlighting the hazard in its top 10 list, ECRI hopes to spur hospitals to give more attention to these other uses, he says. So far, there are no reports of adverse events related to radiation use in the operating room, he says.
"We think people should be looking at these issues now," says Launders.
Include float staff in training
The first step is to determine where radiation is being used in the hospital, outside of traditional radiology. This includes imaging technology in the OR.
ECRI: Protect OR staff from radiation
ECRI Institute, an independent health care research firm based in Plymouth Meeting, PA, offered these recommendations for handling radiation hazards in hybrid ORs:
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Verify that all hybrid OR staff (including surgeons) obtain OR-specific radiation protection training and that they put this training into action. Consult with a medical or health physicist when developing your radiation protection and safety program.
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Nominate a member of the hybrid OR team to assume the day-to-day responsibility for verifying that radiation protection policies and procedures are being followed. This role is not to be confused with that of the radiation safety officer (who oversees procedures for the entire organization).
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Assess the adequacy of existing built-in radiation protection infrastructure. Consider implementing additional personal radiation safety equipment as needed, such as specialized radiation shield garments.
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Consider implementing real-time monitoring to ascertain the effectiveness of radiation safety training, particularly if the analysis of badges proves ineffective at determining the cause of — and steps needed to correct — clinician overexposure.
All of the employees who could be exposed should receive training about ionizing radiation and preventive measures, according to the ECRI recommendations. Because OR staff often float among different rooms, it's important to include everyone who could work in a hybrid OR, Launders says.
It's important to engage the OR staff and managers in this process, he says.
The amount of ionizing radiation that can be present in an OR varies based on a number of factors, including the length of the surgery and the techniques of the surgeon.
One way to educate OR staff about the presence of radiation is to give them electronic badges that display the radiation exposure on a real-time monitor in the room. Sometimes by simply moving a few feet, they can greatly reduce exposure, Launders says.
"There's no better way of teaching people than giving them instant feedback," he says.
Lead aprons are important protective gear, says ECRI. Other barriers also may provide a benefit.
As imaging becomes an increasingly important part of surgical procedures, hospitals will need to continually adapt their radiation protection programs, he says. They also will need to keep lifetime exposure records for those who are monitored, he says.
[Editor's note: More information about ECRI's report on the "Top Ten Health Technology Hazards of 2014" is available at www.ecri.org/2014hazards. The Association of peri-Operative Registered Nurses (AORN) has a toolkit on reducing radiation hazards in ambulatory surgery at www.aorn.org/Clinical_Practice/ToolKits/Tool_Kits.aspx.]
