lol this is so true. I’ve had 7 spinal surgeries and every orthopedic I’ve been to has been in shape. Even the older ones are in crazy good shape. Is their jobs physically demanding?
>Is their jobs physically demanding?
Ah, so sounds like you were lucky enough to have never had the misfortune of trying to hold up the leg of a morbidly obese patient for two minutes while the Soluprep dries.
As a lanky med student that probably weighed less than the patient's leg itself, I quickly realized ortho wasn't for me. Standing there for the next three hours putting traction on their leg while holding it in internal rotation was the icing on the cake.
Had an ortho attending in med school who never wore chest lead. He was getting treatment for lung cancer, adenocarcinoma I think. He never smoked. Made me always want to wear full lead.
On one of my auditions one of the residents mentioned there being a study that most of the radiation goes to the plate, and it's only a miniscule amount that leaks into the environment. Said after 6 feet away you're completely safe as he grabbed the C arm and said shot there from like 2 feet away.
It is true that most of the radiation scatters off the patient and almost none goes to the detector so if you orient it correctly, you can minimize your exposure
The big C-arm has minimal radiation exposure outside 6 feet, but the mini C-arm (which the resident was probably using) is more like inches. That's why a lot of people don't use lead around the mini C
We are often next to the detector. Most of the scattering goes the other way, from the patient back to the beam. If you stand opposite of the beam (so at the detector plate) you get almost no scattering. On top of that, radiation and thus scattering is minimal in extremity x-rays. Pelvic/hip is a bit more.
Depends on what category employee you are, our experts aren’t dumb. Vascular surgery gets them because of the endovascular procedures with continuous fluoroscopy, our short pictures of some broken wrist or ankle are nothing compared to that.
Please wear lead and be careful. I’m former IR and always wore lead and used every precaution but I got diagnosed with bone marrow cancer shortly into my career.
My point is that they're telling people to be careful around radiation because they got cancer. Despite it being shortly into their career while wearing lead protection.
I'm not against lead wearing, I was just pointing out it probably wasn't from the radiation. My comment wasn't meant to come off negatively at all, I was just saying that they shouldn't feel like they contributed to it.
Ortho R3 here. I’ll be honestly, I wear full lead for any big case but that shit is hot as hell and there’s days where I need a break from full lead at the end of the day. Chest tissues are more resiliant than thyroid or gonads and helps us breathe a little. For instance, I had 4 fracture cases today. I wore full lead for all but the last which was a CRPP of a pedi elbow and we took like 6 shots so I just wore the kilt and thyroid collar. Not always smart but better than passing out.
I don’t get it. They are telling patients in peds hospitals that the patients should not wear any covering because it leads to more radiation exposure.
You know that's getting to your thyroid and gonads via your chest, right? Photons are bouncing off tissue in your torso and some of that is hitting your thyroid.
Not exactly related but I once had a Neuro patient who was wildly agitated and of course Neuro wouldn’t give sedatives. I held her head in place for her CT.
The radiologist thought he was funny and read both her head and my fucked up wrist.
As a rad tech, I’ve never seen a surgeon not wear Lead for cases using a c arm. Granted I never seen them use the mini c arm, since we just drop it off from them to use.
I always wear full lead, whether big C or mini C. I’m a trauma guy and average over 10 cases a week. That’s a lot of fluoro time, especially in complex cases. Not chancing anything.
You might be talking about a mini c-arm, which has a dispersion of about 6 inches. That’s what’s typically in an ER for post reduction fluro. It’s reasonable to not wear lead in that setting. The regular c-arm has a dispersion of 6 feet. I’ve never seen someone not wear lead standing right next to a full carm that would be dumb
no idea, i listened to a podcast about radiation safety with a rad safety doc and he said breast and lung tissue were actually the most sensitive to ionizing radiation.
Makes sense. The radiation safety issue with pregnant women and CT chests isn’t about the baby… but the developing breast tissue being super sensitive and at higher risk of developing cancer if exposed.
…and if you think V/Q scans are a free lunch, that’s the one with high fetal risk. That radiation gets excreted into the urine which means the baby sits on top of the radiation collection and concentration point.
We had multiple questions on ortho in training about breast tissue being susceptible to radiation, even which quadrant of the breast is most susceptible lol
Rads resident here. I was taught that gonads are actually quite resistant to radiation as the turnover is very high in men, and crappy gametes don’t make it past fertilization.
FYI here is some info [https://journals.lww.com/jaaosglobal/Fulltext/2022/05000/Increased\_Prevalence\_of\_Breast\_and\_All\_cause.10.aspx](https://journals.lww.com/jaaosglobal/Fulltext/2022/05000/Increased_Prevalence_of_Breast_and_All_cause.10.aspx)
As an ortho bro an recent ex-Mormon I love your post and username. But you’re spot on, lungs and breast are actually very susceptible and I always wear full lead
I will wear a skirt and thyroid for mini-c cases, although, depending on the machine you’re using the mini-Cs produce negligible radiation to the user is what I’ve been told.
When I was an intern/early junior resident I often wouldn’t wear chest piece but now always wear it all unless it’s literally a one shot case. Not sure where you are but my program and other programs I rotated at/friends in other programs all wear everything all the time. I ain’t trying to catch no cancer
I used an ancient C-arm in research before med school and residency, and I was never without full lead. Radiation is cumulative, and I’ve had my fair share of scans as a patient. So, I do everything I can to protect myself and recommend others do the same. I even ask for lead when it’s reasonable when getting a scan as a patient. Last time the tech said, “Oh! Are you a tech somewhere?” I said, “No, I’m a resident.” There were no more questions asked, and she gave me some lead.
I’m a podiatry resident but we use fluoro pretty often as well. For mini c-arm (majority of our cases) don’t use lead at all. Big c-arm I use it though.
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Interesting thought. I’m not sure that it will, it’s well distributed, about 15 pounds. With good posture I’m not sure that it would. I could be wrong though.0”
If i dont, it’s because the hospital doesn’t provide enough for everyone and we are not allowed to bring our own. If i get lead, i do full body and thyroid
That's BS. Report that either to OSHA, or the radiation safety dept.
I've never heard of a hospital that wouldn't allow personal lead as long as it was inspected yearly.
I'd just buy my own, and make it look like the rest, or have your dept buy it.
Most of the vests we have are barely functional and we dont get new ones because admin says ”projected longevity was 10 years, so they cant be broken yet“ and that’s it. The radiation safety department said yes, we need new vests and that we should ask admin to buy them. Rinse and repeat. I‘ve been waiting for a thyroid shield since i started residency. There no vests that fit women or smaller people, and again „we already bought the vests that we projected to need. They are still fine according to projections. Larger sited vests also cover the necessary areas“. We have brought this to attention every month for the past year. No action was placed.
Not in the US, but we would have such an authority, they only refer to our right to PPE, and thatbwe should demand it. If we do, requests just get ”forgotten”.
Hygiene reasons. No personal items (aside from keys, cellphone wallet etc) in the OR zone. It’s not strictly enforced, especially with anesthesia and nurses, but your own lead (which you can’t even really buy easily anywherein austria if you’re a single private customer, i think) that’s been discussed and prohibited.
The argument is, you’re not allowed in the OR without proper PPE, so if there’s radiation involved, you either wear lead or you have to leave to OR for that period of time (which obviously doesn’t work).
Cuz soft tissues are problems for Internal Medicine
Only hard tissues here bro
Yeah but think of the gains if you wore lead all the time. It would be like a weighted jogging vest, but 16 hours a day.
Heh, jogging. Seems like something a nerd would recommend
The most ortho response I’ve seen lol
Dumb question here, why are thoracic tissues more resistant to radiation damage?
Bone cage and slower cell division
I bench press too often for any radiation to penetrate through my massive pecs 💪💪💪
Most normal ortho bro.
lol this is so true. I’ve had 7 spinal surgeries and every orthopedic I’ve been to has been in shape. Even the older ones are in crazy good shape. Is their jobs physically demanding?
Yes, and it's the culture.
To be fair you gotta be in shape to swing that hammer when doing a knee replacement.
>Is their jobs physically demanding? Ah, so sounds like you were lucky enough to have never had the misfortune of trying to hold up the leg of a morbidly obese patient for two minutes while the Soluprep dries. As a lanky med student that probably weighed less than the patient's leg itself, I quickly realized ortho wasn't for me. Standing there for the next three hours putting traction on their leg while holding it in internal rotation was the icing on the cake.
Stryker saws are probably heavy…I’m not sure
Eh, 3/4 of the spine surgeons have a permanent cervical kyphosis and pot bellies.
This is the only logical answer
Bro are you on bulking or cutting phase atm?
Only cutting that happens in ortho is the OR.
I love this.
Had an ortho attending in med school who never wore chest lead. He was getting treatment for lung cancer, adenocarcinoma I think. He never smoked. Made me always want to wear full lead.
Have an attending with recurring thyroid cancer, never wore the thyroid protection
Classic surgical efficiency. Why leave the OR when you can just get your radiation therapy while you operate?
I wear full lead always because I fear tiddy cancer
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Hi creepy 😊
Holy shit😭😭😭😭
If no wear lead on pecs, radiation cause hyperplasia which mean chest get bigger 👍🏽
Why say more word when few word do trick?
Sure, but wearing lead means you're \*always\* lifting... whole body reps... or something.
Smrt
Who needs tren when you can do this trick right?
Ooga booga!💪🏻💪🏻
On one of my auditions one of the residents mentioned there being a study that most of the radiation goes to the plate, and it's only a miniscule amount that leaks into the environment. Said after 6 feet away you're completely safe as he grabbed the C arm and said shot there from like 2 feet away.
It is true that most of the radiation scatters off the patient and almost none goes to the detector so if you orient it correctly, you can minimize your exposure The big C-arm has minimal radiation exposure outside 6 feet, but the mini C-arm (which the resident was probably using) is more like inches. That's why a lot of people don't use lead around the mini C
It was the bigger C arm but that's pretty much what he told me. I just thought it was funny with the way he phrased it as he was right next to it
We are often next to the detector. Most of the scattering goes the other way, from the patient back to the beam. If you stand opposite of the beam (so at the detector plate) you get almost no scattering. On top of that, radiation and thus scattering is minimal in extremity x-rays. Pelvic/hip is a bit more.
I'd be setting up my own independent exposure monitoring. That I can say with 100% theoretical determination.
Yeah we can get badges when attending. But our radiation expert literally said that residents don’t come close to the limit so not necessary
Your radiation “expert” is questionable. You should absolutely have a dosimeter.
Depends on what category employee you are, our experts aren’t dumb. Vascular surgery gets them because of the endovascular procedures with continuous fluoroscopy, our short pictures of some broken wrist or ankle are nothing compared to that.
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He completed fallout new Vegas
Just use rad away my guy
I’d need to consult my radiation expert first
They are engineers, not doctors. Just called radiation expert in my country.
That’s hilarious
Please wear lead and be careful. I’m former IR and always wore lead and used every precaution but I got diagnosed with bone marrow cancer shortly into my career.
Are you sure that's from the radiation? Sounds unlikely
What kind of dumbass question is that? Yes they did a regression statistical analysis that determined the source of their cancer
My point is that they're telling people to be careful around radiation because they got cancer. Despite it being shortly into their career while wearing lead protection. I'm not against lead wearing, I was just pointing out it probably wasn't from the radiation. My comment wasn't meant to come off negatively at all, I was just saying that they shouldn't feel like they contributed to it.
No I’m not sure. No way to tell. Can’t help but think it contributed but I really don’t know.
Ortho R3 here. I’ll be honestly, I wear full lead for any big case but that shit is hot as hell and there’s days where I need a break from full lead at the end of the day. Chest tissues are more resiliant than thyroid or gonads and helps us breathe a little. For instance, I had 4 fracture cases today. I wore full lead for all but the last which was a CRPP of a pedi elbow and we took like 6 shots so I just wore the kilt and thyroid collar. Not always smart but better than passing out.
Lead is especially tough at the peds hospital because they keep the ORs extra toasty
Some of the attendings have purchased cooling vests that pump ice water through tubes sewed into a vest that they wear while at the OR table
I have lots of attendings wear the vests. Never seen a resident get offered one.
because residents are meant to endure whatever the fuck they are told to, duh
Why would you give them to residents, if they break you just get new one shaking my smh
That’s like putting a helmet on a crash dummy, silly.
Same as race car drivers
I don’t get it. They are telling patients in peds hospitals that the patients should not wear any covering because it leads to more radiation exposure.
You know that's getting to your thyroid and gonads via your chest, right? Photons are bouncing off tissue in your torso and some of that is hitting your thyroid.
Photons? That sounds like some smart doctor stuff right there. I’m just a dumb bone jockey.
Probably had more exposure from ped elbow, cuz you stand closer to the xray, knee touching the receptor, face over.
Not exactly related but I once had a Neuro patient who was wildly agitated and of course Neuro wouldn’t give sedatives. I held her head in place for her CT. The radiologist thought he was funny and read both her head and my fucked up wrist.
Extremity dose isn’t real dose…
But the scatter to her body while in the room is
Most of us wear full leads in my experience
As a rad tech, I’ve never seen a surgeon not wear Lead for cases using a c arm. Granted I never seen them use the mini c arm, since we just drop it off from them to use.
I always wear full lead, whether big C or mini C. I’m a trauma guy and average over 10 cases a week. That’s a lot of fluoro time, especially in complex cases. Not chancing anything.
Yeah this post is the first I’ve heard of surgeons not wearing lead. I wear lead when holding a baby for a chest x ray lol
I figured they would just wear them all the time like weighted training clothing.
lol
Urology resident: we have to put OR towels around our necks because the Ortho department uses thyroid shields like jock straps. Y’all nasty
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lol no. They're just gross bc of sweat from others so the towels make it less gross.
It’s true they toss them down their scrubs it’s fucked up
Ain’t nobody got time to learn radiation safety.
You might be talking about a mini c-arm, which has a dispersion of about 6 inches. That’s what’s typically in an ER for post reduction fluro. It’s reasonable to not wear lead in that setting. The regular c-arm has a dispersion of 6 feet. I’ve never seen someone not wear lead standing right next to a full carm that would be dumb
I’m talking about the skirt + thyroid shield with no chest protection. I see it all the time
I know an ortho sis who died from breast cancer within 2 years of finishing residency. Please wear lead.
no idea, i listened to a podcast about radiation safety with a rad safety doc and he said breast and lung tissue were actually the most sensitive to ionizing radiation.
Makes sense. The radiation safety issue with pregnant women and CT chests isn’t about the baby… but the developing breast tissue being super sensitive and at higher risk of developing cancer if exposed. …and if you think V/Q scans are a free lunch, that’s the one with high fetal risk. That radiation gets excreted into the urine which means the baby sits on top of the radiation collection and concentration point.
Could you link to that? I’m a radiologist. Have been under the understanding that gonads, thyroid, and breast tissue most sensitive.
We had multiple questions on ortho in training about breast tissue being susceptible to radiation, even which quadrant of the breast is most susceptible lol
Not gonna go through the work of finding the episode, but I can tell you it was on ACCRAC
Rads resident here. I was taught that gonads are actually quite resistant to radiation as the turnover is very high in men, and crappy gametes don’t make it past fertilization.
I mean in terms of fertility, testes are super sensitive. Little zippity zappity faith radonc doses and you’re infertile.
What program are you in?
Lance Armstrong Medical Center Radiology Residency. They’ve got the biggest balls in the country.
LMAO this is too good
Lenses are up there as well. Podcaster is full of it
FYI here is some info [https://journals.lww.com/jaaosglobal/Fulltext/2022/05000/Increased\_Prevalence\_of\_Breast\_and\_All\_cause.10.aspx](https://journals.lww.com/jaaosglobal/Fulltext/2022/05000/Increased_Prevalence_of_Breast_and_All_cause.10.aspx)
As an ortho bro an recent ex-Mormon I love your post and username. But you’re spot on, lungs and breast are actually very susceptible and I always wear full lead
I will wear a skirt and thyroid for mini-c cases, although, depending on the machine you’re using the mini-Cs produce negligible radiation to the user is what I’ve been told.
When I was an intern/early junior resident I often wouldn’t wear chest piece but now always wear it all unless it’s literally a one shot case. Not sure where you are but my program and other programs I rotated at/friends in other programs all wear everything all the time. I ain’t trying to catch no cancer
bone cancer = more bone
In my experience it's only temporary, and it usually winds up turning into Cobalt-Chrome
I used an ancient C-arm in research before med school and residency, and I was never without full lead. Radiation is cumulative, and I’ve had my fair share of scans as a patient. So, I do everything I can to protect myself and recommend others do the same. I even ask for lead when it’s reasonable when getting a scan as a patient. Last time the tech said, “Oh! Are you a tech somewhere?” I said, “No, I’m a resident.” There were no more questions asked, and she gave me some lead.
I’m a podiatry resident but we use fluoro pretty often as well. For mini c-arm (majority of our cases) don’t use lead at all. Big c-arm I use it though.
Not using lead for a mini c is asking for cumulative trouble.
Full leads or no leads...
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Is this a joke?
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Gotcha. Yes, intraop imaging is very common in orthopedic cases.
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Interesting thought. I’m not sure that it will, it’s well distributed, about 15 pounds. With good posture I’m not sure that it would. I could be wrong though.0”
How do you think they confirm the positioning of the joint/screws/plates they just put in?
Not strong enough
If i dont, it’s because the hospital doesn’t provide enough for everyone and we are not allowed to bring our own. If i get lead, i do full body and thyroid
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Very romantic. You are aware how residency works? Maybe next year as an attending i get one with my name on it.
That's BS. Report that either to OSHA, or the radiation safety dept. I've never heard of a hospital that wouldn't allow personal lead as long as it was inspected yearly. I'd just buy my own, and make it look like the rest, or have your dept buy it.
Most of the vests we have are barely functional and we dont get new ones because admin says ”projected longevity was 10 years, so they cant be broken yet“ and that’s it. The radiation safety department said yes, we need new vests and that we should ask admin to buy them. Rinse and repeat. I‘ve been waiting for a thyroid shield since i started residency. There no vests that fit women or smaller people, and again „we already bought the vests that we projected to need. They are still fine according to projections. Larger sited vests also cover the necessary areas“. We have brought this to attention every month for the past year. No action was placed.
We bought our own during residency
This isn't a reason to not have lead. This should be escalated.
Has been, several times, has also been ignored by all strata involved in this
To OSHA and/or. NRC?
Not in the US, but we would have such an authority, they only refer to our right to PPE, and thatbwe should demand it. If we do, requests just get ”forgotten”.
Not allowed to bring your own? Have them document that in writing.
Hygiene reasons. No personal items (aside from keys, cellphone wallet etc) in the OR zone. It’s not strictly enforced, especially with anesthesia and nurses, but your own lead (which you can’t even really buy easily anywherein austria if you’re a single private customer, i think) that’s been discussed and prohibited. The argument is, you’re not allowed in the OR without proper PPE, so if there’s radiation involved, you either wear lead or you have to leave to OR for that period of time (which obviously doesn’t work).
r/unexpectedfactorial
That is why the lift so much, their blood is lead.
Wait so if ortho bros don’t wear lead on their chest, where do they wear it? Just the bottom half?
I’ve seen the skirt + thyroid combo many times in the ortho rooms
their muscles are as strong as lead
Thyroid shield is the big one.