A Radiation Safety Training Program Results in Reduced Radiation Exposure for Orthopaedic Residents Using the Mini C-arm

Abstract

Background Fluoroscopy during fracture reduction allows a physician to assess fractures and immediately treat a pediatric patient. However, concern regarding the effects of radiation exposure has led us to find ways to keep radiation exposures as low as reasonably achievable. One potentially simple way, which to our knowledge has not been explored, to decrease radiation exposure is through formal education before mini C-arm use. Questions/purposes We questioned whether a radiation safety educational program decreases radiation (1) time and (2) exposure among residents and patients.Patients and Methods This is a retrospective study in which second-year residents underwent a 3-hour educational program regarding mini C-arm use and radiation safety taught by our institution's health physics department. We evaluated the records of all patients who underwent a pediatric both-bone forearm or distal radius fracture reduction in the emergency department 3 months before the educational program or after the program. To be included in the study, records included simple both-bone forearm fractures, simple distal radius fractures, and patient age younger than 18 years, and could not include patients with multiple fractures in the same limb. This resulted in study groups of 53 and 45 patients' records in the groups before and after the educational session, respectively. Radiation emission from the mini C-arm between both groups were compared. Results Exposure time with the mini C-arm was longer in patients treated before the educational intervention than in those treated after the intervention (patients with both-bone forearm fractures: mean = 41.2, SD = 24.7, 95% CI, 23.14-59.26 vs mean = 28.9, SD = 14.4, 95% CI, 15.91-41.89, p = 0.066; patients with distal radius fractures: mean = 38.1, SD = 26.1, 95% CI, 25.1-51.1 vs mean = 26.7, SD = 15.8, 95% CI, p = 0.042). Calculated radiation exposure with the mini C-arm was larger in patients treated before the educational intervention than in those treated after the intervention (patients with both-bone forearm fractures: mean = 90.9, SD = 60.9, 95% CI, 51.06-130.74 vs mean = 30.4, SD = 18.5, 95% CI, 16.73-44.07, p \ 0.001; patients with distal radius fractures: mean = 83.1, SD = 58.9, 95% CI, 54.75-111.45 vs mean = 32.6, SD = 26.4, 95% CI, 20.07-45.13, p \ 0.001). Conclusions A radiation-safety program resulted in decreased radiation exposure to residents and patients, and

Radiation safety education and compliance with safety procedures—The Korea Nurses’ Health Study

“…These results are consistent with the results of a study involving orthopaedic residents who used a mini C-arm and were exposed to radiation for significantly shorter periods following participation in a radiation safety training programme lasting 3 hours (Gendelberg, Hennrikus, Slough, Armstrong, & King, 2016). The results are also consistent with a study conducted by Sheyn et al (2008), which examined the effects of radiation safety education in doctors and employees of a paediatric interventional radiology suite and showed that doctors' use of leaded eyeglasses and hanging shields increased significantly following receipt of the education.…”

“…These results are consistent with the results of a study involving orthopaedic residents who used a mini C‐arm and were exposed to radiation for significantly shorter periods following participation in a radiation safety training programme lasting 3 hours (Gendelberg, Hennrikus, Slough, Armstrong, & King, ). The results are also consistent with a study conducted by Sheyn et al.…”

Decreased Radiation Exposure Among Orthopedic Residents Is Maintained When Using the Mini C-Arm After Undergoing Radiation Safety Training

“…[9][10][11][16][17][18][19][20] A previous study found that an educational program on radiation safety significantly decreased both radiation time and amount in the short term. 12 For residents at the end of the second academic year who had undergone mini C-arm training at the beginning of the year, there was a statistically significant decrease in reduction time for distal radius fractures. Although no significant decrease was found for both bone forearm fracture reduction times, a reduction was noted in radiation emitted with these fracture types.…”

“…Sumko et al 11 showed the importance of technique and experience for radiation safety; more junior residents received greater radiation exposure than more experienced residents. Further, Gendelberg et al 12 showed that an educational program on radiation safety decreased radiation time and radiation exposure among residents in the short term. However, it is unclear whether these effects are maintained.…”

“…The current study is a retrospective follow-up study to the work of Gendelberg et al 12 The current study examined whether radiation safety education was still effective in reducing radiation exposure at the end of the academic year. Radiation exposure time and the amount of whole body radiation incurred by the resident performing the reduction were compared among 3 groups: 53 consecutive pediatric patients undergoing fracture reduction before the educational session (group A), 45 consecutive pediatric patients undergoing fracture reduction in the emergency department after the session (group B), and 46 consecutive pediatric patients undergoing reduction for both bone forearm fracture and distal radius fracture in the emergency department at the end of the academic year, 11 months after the educational session (group C).…”