2023 General Surgery Presentations

Ashley N Flinn, MD; Tesserae A Komarek, MD; Marlin W Causey, MD; San Antonio Uniformed Services Health Education Consortium

Objectives: The Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements (CPRs) are inconsistent across subspecialties in mandating radiation safety education and standardizing radiation safety practices. The General Surgery CPRs do not require radiation safety education or provide lead shielding despite the routine use of fluoroscopy and x-ray. This project aimed to define the proportion of general surgery cases involving ionizing radiation during post-graduate year two (PGY2) at a single institution and to survey current resident attitudes regarding access to radiation safety education and shielding.

Methods: Anonymized ACGME Case Logs of general surgery residents who completed PGY2 were included in determining the total PGY2 cases logged, the proportion of each resident’s cases involving the use or potential use of ionizing radiation, rotation subspecialty, and the hospital site for each procedure. A survey was administered to all current residents to assess attitudes regarding the adequacy of radiation safety education, availability of radiation monitoring, and access to shielding.

Results: Of the 35 residents currently enrolled, 20 residents (57%) completed PGY2, with a total of 6315 cases recorded. 10.7% of each resident’s case volume involved ionizing radiation, whereas 23.0% involved the use or potential use of ionizing radiation, with 33.6% of cases performed at the home institution. Rotations with greater than 15% of cases involving the use or possible use of ionizing radiation included cardiothoracic surgery (80%), vascular surgery (72.9%), surgical oncology (17.5%), and general surgery (17.5%). The radiation safety attitudes survey demonstrated that 100% of respondents had never received feedback about their radiation exposure, 100% had never received formal radiation education before starting their training program, 100% had never been issued a dosimeter, and 83.3% felt they did not have acceptable and adequate access to radiation safety protection equipment across all rotations and institutions.

Conclusion: Nearly one-quarter of all cases performed in PGY2 involve the use or potential use of ionizing radiation over a breadth of rotations. This underscores the need for early radiation safety education and reeducation before rotations with high radiation exposure. Personal protection and monitoring also require adequate access to lead shielding and issuing dosimeters for radiation safety monitoring due to the misperception of low radiation exposure. The radiation safety attitudes survey highlighted current deficiencies in radiation safety education and access to adequate lead shielding, which should be more carefully analyzed in future studies and with future accreditation standards development.