Updated: 6/26/2017

Occupational Health

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Radiation Exposure and Fluoroscopy
  • Factors which increase radiation exposure levels during use of fluoroscopy  
    • imaging large body parts
    • positioning extremity closer to the x-ray source 
    • use of large c-arm rather than mini c-arm
      • radiation exposure is minimal during routine use of mini-c-arm fluoroscopy unless the surgical team is in the direct path of the radiation beam 
  • Factors to decrease radiation exposure to patient and surgeon 
    • maximizing the distance between the surgeon and the radiation beam
    • minimizing exposure time
    • manipulating the x-ray beam with collimation
    • orienting the fluoroscopic beam in an inverted position relative to the patient 
    • strategic positioning of the surgeon within the operative field to avoid direct path of beam
    • use of protective shielding during imaging
Risk of Transmission
  • Risk of HIV transmission
    • needlestick  
      • seroconversion from a contaminated needlestick is ~ 0.3% 
        • exposure to large quantities of blood increases risk
      • seroconversion from exposure to HIV contaminated mucous membranes is ~0.09%
    • frozen bone allograft
      • risk of transmission is <1 per million
        • donor screening is the most important factor in prevention
        • no reported cases of transmission from frozen bone allograft since 2001
    • blood transfusion
      • risk of transmission from blood transfusion is 1/500,000 per unit transfused
      • seronegative blood may still transmit virus due to delay between HIV infection and antibody development
  • Risk of Hepatitis B transmission
    • needlestick
      • 37% to 62% eventually seroconvert following needlestick
      • 22 to 31% develop clinical Hepatitis B infection following needlestick
  • Risk of Hepatitis C transmission
    • needlestick
      • 0.5 to 1.8% risk of transmission
Resident Surgeon Work Duty Hours
  • ACGME has restricted work hours in order to address impaired performance by residents caused by long duty hours
  • Duty hours 
    • include
      • clinical time
      • academic hours
      • administrative work  
      • time on call
        • no more than 1 day per every 3 days in house 
        • must include a 10-hour period of  "off-time" between
          • clinics
          • on-call  
    • restricted to 80 or less per week (averaged over a 4 week period)
    • 10% increase allowed if justified by educational value
    • 1 day in 7 must be a day off (averaged over 4 week period)
  • Results of new duty hours
    • early evaluations have caused concern over issues of 
      • patient safety 
      • continuity of care
        • communication and transfers in care have been cited as sources of decreased continuity of care as a sequelae of the 80-hour resident physician work week  
 

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Questions (6)
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(OBQ10.179) Which of the following configurations creates the least radiation exposure for the operative surgeon during upper extremity surgery? Review Topic

QID: 3272
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1

Imaging the thumb positioned against the x-ray source with the standard C-arm

1%

(10/1853)

2

Imaging the wrist positioned against the x-ray source with the standard C-arm

2%

(44/1853)

3

Imaging the thumb positioned against the image intensifier with the mini C-arm

59%

(1094/1853)

4

Imaging the wrist positioned against the image intensifier with the mini C-arm

20%

(379/1853)

5

Imaging the thumb positioned against the x-ray source with the mini C-arm

17%

(317/1853)

L 3

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(OBQ10.95) When using C-arm fluorocopy, patient radiation exposure will be increased with which of the following? Review Topic

QID: 3183
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1

The extremity is positioned closer to the image intensifier

21%

(311/1480)

2

A larger body part is imaged compared to a smaller body part

72%

(1062/1480)

3

Use of radiation beam collimation

6%

(85/1480)

4

Mini C-arm fluroscopy is used instead of large C-arm fluroscopy

1%

(14/1480)

5

Decreased duration of imaging

0%

(6/1480)

L 3

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(OBQ09.88) All of the following are cited as a concern for decreased continuity of care when "signing out" patient care from one provider to another EXCEPT? Review Topic

QID: 2901
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1

Omitting the patients' current clinical condition

3%

(34/1227)

2

Omitting guidance for events likely to occur on the next shift

4%

(47/1227)

3

Signing out to physician extenders instead of a resident physician

78%

(956/1227)

4

Rationale not given for plans provided to the covering physician

6%

(77/1227)

5

Tasks not assigned to the covering physician for completion

9%

(106/1227)

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(OBQ06.3) An orthopaedic surgeon is closing a total knee replacement incision of a patient with HIV and accidently sustains a needlestick. What is the surgeon's approximate risk of contracting the virus? Review Topic

QID: 14
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1

0.3%

92%

(826/895)

2

3%

6%

(51/895)

3

10%

1%

(8/895)

4

20%

0%

(3/895)

5

30%

0%

(1/895)

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