Most Likely Cause of Excessive OR Radiation Exposure
The most likely cause of excessive radiation exposure in the operating room is prolonged fluoroscopy use without proper shielding (Option C). This represents the primary mechanism by which OR personnel accumulate dangerous radiation doses during orthopedic procedures.
Why Prolonged Fluoroscopy Without Shielding is the Culprit
Fluoroscopy accounts for the majority of cumulative radiation exposure despite lower per-second output compared to static radiographs. The American College of Cardiology guidelines emphasize that fluoroscopy was found to be a greater source of total radiation by a ratio of 6.3 to 1 compared to cine imaging, specifically because of its protracted use during procedures 1. This principle directly applies to orthopedic surgery where fluoroscopy is used continuously for real-time guidance.
The Critical Role of Shielding
Proper shielding reduces exposure by approximately 95% beneath a 0.5-mm lead apron, yet inconsistent use of appropriate protective equipment remains a major problem 1.
The combination of limiting exposure time, maintaining distance, and using shielding should prevent excessive exposure in every operator, according to established radiation safety principles 1.
When these protective measures fail—particularly shielding—OR personnel face significantly elevated radiation doses 1.
Why the Other Options Are Less Likely
Patient Radiation Dose (Option A)
While patients do receive radiation during procedures, excessive OR exposure specifically refers to occupational exposure of healthcare workers, not patient dose 1.
The question explicitly states "excessive radiation exposure in the OR" which contextually refers to personnel exposure, as this is the primary safety concern that triggers investigations 1.
X-ray Source Distance (Option B)
Positioning the X-ray source far from the operative site actually reduces scatter radiation to the surgeon, not increases it 2.
Studies demonstrate that proper positioning with the X-ray source posterior to the patient provides the lowest levels of scatter radiation to personnel in normal working positions 2.
Greater distance from the radiation source is a protective factor, not a causative factor for excessive exposure 1.
The Evidence on Fluoroscopy Duration and Shielding
Documenting fluoroscopy time per case is specifically recommended as valuable in assessing patterns contributing to increased radiation exposure 1. This recommendation exists precisely because prolonged fluoroscopy time is a recognized primary cause of excessive exposure.
Operator Technique Impact
Significant reductions in exposure occur when operators modify technique to limit fluoroscopy duration—waist-level exposures decreased from 3.3 mrem to 1.4 mrem per week when operators restricted certain views 1.
Inexperienced surgeons demonstrate higher total fluoroscopy time and higher mean radiation exposure compared to experienced surgeons 3, further supporting that prolonged fluoroscopy use is the key modifiable risk factor.
The Shielding Gap
Studies reveal that healthcare workers are inconsistent in their use of appropriate shielding, with radiation badges most commonly exceeding established limits in procedural areas 1.
Without proper shielding, the surgeon's dominant hand receives the most exposure per case 4, and unprotected areas like the head, neck, and hands face significant scatter radiation 2.
Common Pitfalls to Avoid
Do not assume standard lead aprons provide complete protection—they offer approximately 95% reduction to covered areas but leave critical exposure points at the head, neck, thyroid, and hands 1, 2.
Avoid complacency with fluoroscopy duration—even though fluoroscopy has lower per-second radiation output than static X-rays, its cumulative effect from prolonged use creates the greatest total exposure 1.
Never neglect suspended leaded acrylic shields—their use significantly impacts overall exposure levels 1.