Establishing local diagnostic reference levels for common orthopaedic procedures using the mini C-arm fluoroscope

Kropelnicki, Anna; Eaton, Rosemary; Adamczyk, Alexandra; Waterman, Jacqueline; Mohaghegh, Pegah

doi:10.1259/bjr.20190878

Cited by 5 publications

(3 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study, we demonstrated that the overall amount of radiation seen by patients during hand and wrist fracture fixation is low, with a median DAP of 4.8 cGycm 2 , median ED of 0.13 μSv, and median exposure time of 43 seconds. This is in line with Kropelnicki et al, 14 who looked at 1664 extremity procedures requiring the mini c-arm and measured median DAP to be 2.98 cGycm 2 for hand, 5.18 cGycm 2 for wrist, 2.78 cGycm 2 for forearm, 8.71 cGycm 2 for elbow, and 3.71 cGycm 2 for foot and ankle procedures. Madhvani et al 15 reported median DAP values of 2.73 cGycm 2 for wrist ORIF, 1.05 cGycm 2 for phalangeal ORIF, and 2.36 cGycm 2 for all CRPPs.…”

Section: Discussionsupporting

confidence: 86%

Investigating Patient-Level Radiation Exposure in Hand and Wrist Fracture Surgery

Christopher

Hu³

et al. 2022

Ann Plast Surg

View full text Add to dashboard Cite

Background Although occupational exposure to radiation has been previously studied in the hand surgery literature, there is a paucity of studies looking at radiation exposure to the patient during fluoroscopy-guided hand surgery. We aimed to describe the level of radiation experienced by patients undergoing common hand and wrist fracture fixation and to identify risk factors for increased radiation exposure. Methods We performed a retrospective review of patients at a single institution who underwent fracture fixation of the hand, wrist, or forearm requiring mini c-arm fluoroscopic guidance from 2016 to 2020. Data points collected included patient demographics, procedural details, and indicators of radiation exposure including dose-area product (DAP), total intraoperative images, and total fluoroscopy time. Effective dose (ED) was calculated using DAP, field size, and a previously established conversion factor. Results The final sample included 361 patients with an average age of 46 years. Procedures included fixation of forearm fractures (3.3%), distal radius fractures (35.7%), metacarpal fractures (30.8%), and phalangeal fractures (30.2%). The median number of intraoperative images acquired was 36, median total fluoroscopy time was 43 seconds, median DAP was 4.8 cGycm2, and median ED was 0.13 μSv. Distal (metacarpal and phalangeal) fractures required more intraoperative images and longer total fluoroscopy time (49 images, 61 seconds) compared with proximal (forearm and distal radius) fractures (39 images, 47 seconds) (images, P = 0.004; exposure time, P = 0.004). However, distal fractures had a lower average ED compared with proximal fractures (0.15 vs 0.19 μSv, P = 0.020). When compared with open procedures, percutaneous procedures had higher DAPs (8.8 vs 4.9 cGycm2, P < 0.001), higher ED (0.22 vs 0.15 μSv, P < 0.001), more intraoperative images (65 vs 36 images, P < 0.001), and longer total fluoroscopy time (81.9 vs 44.4 seconds, P < 0.001). Conclusions Patient-level radiation exposure during fluoroscopy-guided hand and wrist procedures is low relative to other common imaging modalities, such as dental radiographs, chest x-rays, and computed tomography scans, and is comparable with less than a few hours of natural background radiation exposure, highlighting the overall safety of this important technology. Further study should be performed to establish reference ranges, which could lead to improved patient counseling and evidence-based guidelines on patient shielding.

show abstract

Section: Discussionsupporting

confidence: 86%

Investigating Patient-Level Radiation Exposure in Hand and Wrist Fracture Surgery

Christopher

Hu³

et al. 2022

Ann Plast Surg

View full text Add to dashboard Cite

show abstract

Section: How To Establish Local Drlsmentioning

confidence: 99%

“…Local DRLs have been used in the last years to report patient dose indicators with small samples (e.g., in paediatrics) [7], according to body metrics (7), after installing X-rays systems with new imaging technology, or when national DRLs are still not available for some clinical indications [9][10][11][12]. The PiDRL project [6] recommends establishing local DRLs for emerging or increasing new practices, such as hybrid imaging when the CT is used for diagnostic purposes and paediatric cone-beam CT (CBCT) examinations.…”

Section: How To Establish Local Drlsmentioning

confidence: 99%

How to establish and use local diagnostic reference levels: an ESR EuroSafe Imaging expert statement

et al. 2023

View full text Add to dashboard Cite

Although the Diagnostic Reference Levels (DRLs) have been shown to be an important tool for optimising patient radiation protection, there are still difficulties related to the methodology that should be used to establish and use local DRL values. This statement represents the current view of the EuroSafe Imaging ‘Clinical DRLs’ working group formed with the purpose to produce scientific and educational material on DRLs and promote the concept of local DRLs. Guidelines on how to establish and how to use local DRLs presented herein can be implemented using a multidisciplinary team approach. Local DRLs are easy to determine and implement and they reflect local equipment performance and local clinical needs. They can be updated more frequently than the national DRLs, especially if a dose management system is available. To establish local DRLs, a practical approach could be to collect a reasonable set, i.e., at least 20–30 procedures, of data for well-defined clinical indications and calculate the 3rd quartile values. The median values of the distribution can be set to define the ‘typical values’. The International Commission of Radiological Protection (ICRP) suggests setting ‘typical values’ for newer technologies that enable decreased amounts of radiation exposure for a similar level of image quality. Local DRLs should be similar or lower to the national DRLs. They could be higher only if the clinical benefits for some medical indications are fully explained and reported. Local DRLs may be used as a quality benchmark to track outliers and can be also used as alert values. Key points Guidelines on how to establish and use local DRLs are presented. Local DRLs are easy to determine and implement and can be updated frequently Additionally, local DRLs can be used to track outliers.

show abstract

Typical dose values for intra-operative fluoroscopy during orthopaedic trauma surgery at Larnaca general hospital in cyprus: A five-year retrospective study

Metaxas,

Savvakis,

Skouridi

et al. 2025

Injury

View full text Add to dashboard Cite

Establishing local diagnostic reference levels for common orthopaedic procedures using the mini C-arm fluoroscope

Cited by 5 publications

References 15 publications

Investigating Patient-Level Radiation Exposure in Hand and Wrist Fracture Surgery

Investigating Patient-Level Radiation Exposure in Hand and Wrist Fracture Surgery

How to establish and use local diagnostic reference levels: an ESR EuroSafe Imaging expert statement

Typical dose values for intra-operative fluoroscopy during orthopaedic trauma surgery at Larnaca general hospital in cyprus: A five-year retrospective study

Contact Info

Product

Resources

About