Joint replacements significantly increase radiation exposure to interventionalists
Interventionalists conducting procedures on patients who have total joint replacements are susceptible to increased radiation exposure, according to new research.
Researchers used a water phantom to measure the amount of such exposure when joint prostheses were in the targeted field of view during various percutaneous interventions. They found that due to the greater density of joint implants, interventionalists are exposed to 2.7-3.9 times more radiation when working near metal joint replacements than they are when the prostheses are not present.
“Given the ever-increasing number of lower extremity joint replacement surgeries, interventionalists regularly encounter metallic implants,” corresponding author A.M. Koenig, of the Clinic of Diagnostic and Interventional Radiology at Philipps-University of Marburg in Germany, and co-authors discussed. “In lower extremity angiography, these implants are inevitably in the path of radiation causing an increase in scattered radiation.”
For the simulation study, a water phantom in a clinical angiography system was used to measure the scattered radiation exposure during multiple scenarios. These scenarios included simulations conducted with and without a knee prosthesis and with and without a hip prosthesis made from titanium, aluminum, vanadium, ceramics and polyethylene. Measurements were taken at multiple heights and distances and at different tube angulations to simulate exposure to different body parts of the interventionalist.
For procedures involving hip prostheses, average angulations at a height of 165 cm resulted in doses 2.7 times higher when implants were present compared to when they were not. Similar exposure increases were observed in the presence of knee prostheses also, with interventionalists being exposed to 3.9 times more radiation when working near the metal implant. Experts reported that the average radiation dose over all angulations and all heights was 1491 µSv/h without prosthesis, 4538 µSv/h with a hip prothesis and 5023 µSv/h with a knee prosthesis, respectively.
“Since the X-ray's exposure to the interventionist is predominantly due to scattered radiation from the patient, it changes when the scattering object is changed,” the authors explained. “In the present study, the scattered object was fitted with metal prostheses, all of which increased the exposed scattered radiation.”
The experts urged interventionalists to take extra protective measures when in the presence of metal protheses during procedures and to be especially vigilant shielding their eyes from additional radiation exposure, as it can increase the risk of cataracts.
“If there is a metal prosthesis in the examination area, care should be taken to ensure optimal radiation protection," the research wrote, adding that providers should use "a combination of different radiation protection systems and interventional techniques.”
The detailed research can be viewed in the European Journal of Radiology.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.