evaluation of dose area product in intraoperative radiography during orthopedic and neurosurgical procedures

Introduction: despite the necessity of c-arm and other x-ray imaging devices in operating rooms (ors) and interventional procedures, awareness of their proper and safe usage remains limited. comprehensive education regarding the risks and adverse effects of x-ray exposure has not been adequately provided. this study aims to assess the dose area product (dap) and, consequently, the radiation dose delivered to patients based on various influencing factors. methods: this descriptive-analytical cross-sectional study involved 123 patients undergoing orthopedic and neurosurgical operations at imam reza hospital, birjand, iran. patient demographic information, including height, weight, gender, age, and type of surgery, was recorded confidentially from medical files. imaging parameters, such as kvp, mas, distance from the source, and the number of radiographs, were also documented. dap values were measured at the c-arm output using recorded parameters without altering imaging protocols. measurements were obtained without patient presence, preventing additional radiation exposure. data were analyzed using t-test, anova, mann–whitney u, kruskal-wallis, and pearson’s correlation coefficient. results: this study analyzed dap in 123 surgical patients (89 male, 34 female) across three ors. neurosurgical procedures indicated significantly higher dap (33.27±15.89 µgy·m²) versus orthopedic cases (0.96-1.67 µgy·m², p<0.001). lumbar surgeries required 20.8-22.2 µgy·m² more radiation than peripheral regions after age/bmi adjustment. higher bmi associated with higher dap (18.43±21.84 µgy·m² for bmi >30 vs 1.38±1.53 µgy·m² for bmi<18, p=0.023). no significant age or gender differences were observed (p>0.05). equipment variations among ors significantly affected radiation output despite similar procedures.conclusion: this study highlights key factors affecting surgical radiation exposure, including anatomical site, bmi, and procedure type. spinal, pelvic, and femoral surgeries require particular caution, emphasizing lead apron use and shielding. strict protection protocols are strongly recommended to minimize risks for both staff and patients, ensuring safer operative environments.