AORN Guideline in Focus: Radiation Safety

Radiation is invisible—but the risks are not. The AORN Guideline for Radiation Safety provides evidence-based recommendations to prevent patient and health care worker injury from exposure to medical ionizing radiation during therapeutic, diagnostic, or interventional procedures. The guideline also includes guidance on protective measures related to the administration of radionuclides and radiopharmaceuticals.

Some Key Radiation Safety Practices for the Perioperative Environment

• Establishing a radiation safety program and designating a radiation safety officer (1.1–1.2)
• Monitoring team exposure and providing appropriate shielding (1.3, 1.5)
• Conducting a radiation safety time out before procedures (5.2)
• Maintaining distance and limiting exposure time (6.1)
• Wearing and maintaining leaded protective equipment (7.1–7.2, 7.10)
• Implementing additional safeguards for pregnant team members (8.1–8.3)

Radiation Exposure Risks in the OR

Radiation exposure can come from primary beams, leakage, or scatter—the latter being the most common for OR teams (6.1).

The risk of long-term effects, such as skin injury or cancer, increases with cumulative dose and proximity to the source. Dose can vary depending on the equipment used, the complexity of the procedure, and patient-specific factors like BMI (6.1, 6.3).

Radiation Protection Strategies for Surgical Teams

Follow the time, distance, and shielding principle: keep exposure time short (6.1), maximize your distance from the beam (6.1), and use shielding such as leaded aprons, eyewear, and structural or mobile barriers (7.1–7.2).

Protective gear should be visually inspected before use for damage and tested regularly for effectiveness (7.10).

Team members must be trained, monitored, and provided with the appropriate equipment based on exposure risk (1.5, 1.7).

Radiation Safety for Pregnant OR Staff and High-Risk Procedures

Pregnant team members must follow dose restrictions set by regulation (8.1), wear additional shielding like a wraparound apron (8.2), and use a second dosimeter at waist level beneath the apron to monitor fetal exposure (8.3).

Procedures involving radiopharmaceuticals or radionuclide implants require strict room access, proper transport, clear signage, and patient education for post-op safety (10.8–10.21).

Training and Program Maintenance for Radiation Safety Compliance

Radiation safety isn’t one-and-done. The guideline recommends that perioperative team members receive education and demonstrate competency on radiation protection techniques appropriate to their roles (1.7, 10.20).

Facilities must also retain exposure records and review radiation safety programs at least annually (1.6, 4.5), ensuring practices stay current and compliant.

References

• Salvo JP, Zarah J. Surgeon radiation exposure in hip arthroscopy: a prospective analysis. Orthop J Sports Med. 2015;3(7 Suppl 2): 2325967115S00142. [VC]
• Sciahbasi A, Ferrante G, Fischetti D et al. Radiation dose among different cardiac and vascular invasive procedures: the RODEO study. Int J Cardiol. 2017;240:92–96. [IIIA]   
• van den Haak RFF, Hamans BC, Zuurmond K, Verhoeven BAN, Koning OH. Significant radiation dose reduction in the hybrid operating room using novel x-ray imaging technology. Eur J Vasc Endovasc Surg. 2015;50(4)480–486. [IIB]  
• Hirshfeld JW Jr., Ferrari VA, Bengel FM et al. 2018 ACC/HRS/NASCI/SCAI/SCCT expert consensus document on optimal use of ionizing radiation in cardiovascular imaging—best practices for safety and effectiveness, part 1: radiation physics and radiation biology: a report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways developed in collaboration with Mended Hearts. Catheter Cardiovasc Interv. 2018;92(2)203–221. [IVA]
• Richardson DB, Cardis E, Daniels RD et al. Site-specific solid cancer mortality after exposure to ionizing radiation: a cohort study of workers (INWORKS). Epidemiology. 2018;29(1)31–40. [IIIA]