What are general principles of radiation safety when intraoperative imaging is used?

• A. Increase exposure to improve image.
• B. Minimize exposure with shielding, maintain distance, use protective wear for staff; use proper imaging equipment to limit radiation dose.
• C. Ignore shielding if the patient is stable.
• D. Use flash photography instead.

Answer: (B)

Radiation safety during intraoperative imaging hinges on making exposures as low as reasonably achievable by using time, distance, shielding, and proper equipment settings. The best approach is to minimize exposure for both staff and patient by using shielding such as lead aprons and thyroid shields, maximizing distance from the radiation source when possible, and ensuring protective wear is worn by everyone in the room. In addition, operate the imaging system to limit dose: use the lowest acceptable exposure settings, apply collimation to narrow the beam to the area of interest, and opt for dose-saving techniques like pulsed fluoroscopy and last-image hold, while keeping the equipment well-maintained and correctly calibrated. These practices together reduce radiation dose without compromising essential imaging quality.

Increasing exposure to improve the image would raise risk without meaningful gain in safety. Ignoring shielding leaves staff and patients unnecessarily exposed, and flash photography is not a substitute for proper dose control during intraoperative imaging.