Radiation protection issues with the use of mini C-arm image intensifiers in surgery in the upper limb. Optimisation of practice and the impact of new regulations.

©2004 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.86B3. 14392 $2.00 J Bone Joint Surg [Br] 2004;86-B:333-6. Hospital practice in all areas is constantly evolving because of new medical concepts and technological advances. This is partly driven by the influences of clinical governance and a rigorous medicolegal climate. The search for higher standards of health care has led to the introduction of technological innovations and the need therefore of regulating their use. The mini C-arm image intensifier has made a major contribution to surgery of the upper limb, combining a superior quality of image, ease of use, and relatively low doses of emitted ionising radiation. Low as these radiation doses may be, the protection of those exposed remains a matter of importance. Current regulations make hospital trusts accountable for the safety of all staff and patients exposed to ionising radiation within the hospital. Breaches of the regulations are a criminal offence under the Health and Safety at Work Act and can result in criminal and civil liabilities. The need therefore is to have well-trained personnel with appropriate equipment and systems in place to carry out justified, optimised and safe medical procedures and to be able to identify and deal with accidents, errors and poor practice. The requirement for justification and optimisation is contained within the Ionising Radiation Regulations 19991 and the Ionising Radiation (Medical Exposure) Regulations 2000 (IRMER 2000).2 This and the medicolegal climate have made it essential for all trusts to have formal written local rules and protocols for the safe use of medical radiation.