Insights into Testicular Radiation Exposure in the Orthopedic Surgeon.

Abstract: Testicular radiation exposure has been linked to diminished spermatogenesis, male infertility, and potentially testicular cancer. Despite this, the risk of testicular exposure from intraoperative fluoroscopy to the male orthopedic surgeon has yet to be studied. The purpose of this study is to determine factors associated with unnecessary testicular radiation exposure in male orthopedic surgeons. The study was designed to answer the following questions: (1) Do the designs of lead apron protection result in any differential testicular radiation exposure? (2) Does the position of the surgeon (standing, sitting, and knee position while sitting) alter the amount of testicular radiation exposure? (3) Does any combination of lead apron design and surgeon positioning increase the degree of testicular radiation exposure? A life-sized, whole-body, anthropomorphic phantom simulating an orthopedic surgeon was positioned adjacent to a hand table attached to a standard radiolucent operating table. A digital dosimeter was attached to the groin region beneath a lead apron. Scatter radiation dose equivalent rates were measured during continuous anteroposterior C-arm fluoroscopy of a forearm/hand phantom. Four trials were conducted using three different types of protective lead aprons (cross-back, full-skirt, and half-skirt) in three different positions (standing, sitting with knees 10 cm apart, and sitting with knees 25 cm apart). Radiation dose-equivalent rates were compared using the Student's t-test and analysis of variance. No scatter radiation (measured value of 0.0 mrem min-1 [0.0 Sv min-1]; below minimum detectability of dosimeter) was detected underneath the lead aprons in the standing position and when sitting with the knees 25 cm apart, using all three types of lead. When sitting with the knees 10 cm apart, the mean dose equivalent rate of scatter radiation was higher using the half-skirt (0.01 mrem min-1 [0.000001 Sv min-1]) than the cross-back (below minimum detectability of dosimeter) and skirt aprons (below minimum detectability of dosimeter), but this did not reach statistical significance (p = 0.44). For all apron types and all positions, the use of an apron resulted in significantly less scatter radiation exposure when compared to no protection (p < 0.001). Protective lead aprons are effective at preventing testicular radiation exposure in both the standing and sitting positions. As the only detectable radiation exposure occurred with use of a half-skirt apron when sitting with the knees spread 10 cm apart, cross-back and full-skirt aprons may provide slightly enhanced protection over half-skirt aprons in the sitting position.