Radiation exposure of patients during mini C-arm use: an audit in 2032 procedures

McCann, Mark; Rust, Philippa A; Brown, Katie; Lawrie, David

doi:10.1177/1753193419848575

Cited by 3 publications

(2 citation statements)

References 7 publications

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“…On the other hand, Ammari et al 16 reviewed all upper extremity procedures requiring mini c-arm fluoroscopy over a 6-year period and demonstrated a lower median DAP of 0.48 cGycm 2 and median screening time of 7 seconds for closed procedures as well as a median DAP of 1.88 cGycm 2 and median screening time of 28 seconds for open procedures. Similarly, McCann et al 17 looked at all upper extremity procedures and reported a median DAP of 0.75 cGycm 2 and median screening time of 11 seconds. Although both of these latter studies demonstrated values that are lower than those seen in our study, both examined a broader group of upper extremity procedures including steroid injections and manipulation under anesthesia, which typically require less fluoroscopic guidance and are associated with decreased overall operative times compared with fracture fixation, which was the focus of our study.…”

Section: Discussionmentioning

confidence: 98%

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

Christopher

Hu³

et al. 2022

Ann Plast Surg

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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.

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Section: Discussionmentioning

confidence: 98%

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

Christopher

Hu³

et al. 2022

Ann Plast Surg

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“…A more recent study by McCann et al 15 aimed to set local DRLs for orthopedic upper limb procedures. Their data were grouped according to type of procedure (open/closed) and anatomical area, that is, digits, thumb/hand and wrist/ forearm but did not identify DRLs for individual procedures.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Reference Levels for Common Orthopedic Hand and Wrist Procedures Using Intraoperative Mini C-arm Fluoroscopy

Madhvani

Clark

Kocheta

2021

Hand (New York, N,Y.)

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Background: Diagnostic reference levels are radiation dose levels in medical radiodiagnostic practices for typical examinations for groups of standard-sized individuals for broadly defined types of equipment. This study aimed to contribute to national diagnostic reference levels for common hand and wrist procedures using mini C-arm fluoroscopy. Small joint and digital fracture procedure diagnostic reference levels have not been reported in significant numbers previously with procedure-level stratification. Methods: Data were collected from fluoroscopy logbooks and were cross-referenced against the audit log kept on fluoroscopy machines. A total of 603 procedures were included. Results: The median radiation dose for wrist fracture open fixation was 2.73 cGycm2, Kirschner wiring (K-wiring) procedures was 2.36 cGycm2, small joint arthrodesis was 1.20 cGycm2, small joint injections was 0.58 cGycm2, and phalangeal fracture fixation was 1.05 cGycm2. Conclusions: Wrist fracture fixation used higher radiation doses than phalangeal fracture fixation, arthrodeses, and injections. Injections used significantly less radiation than the other procedures. There are significant differences in total radiation doses when comparing these procedures in hand and wrist surgery. National and international recommendations are that institutional audit data should be collected regularly and should be stratified by procedure type. This study helps to define standards for this activity by adding to the data available for wrist fracture diagnostic reference levels and defining standards for digital and injection procedures.

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Establishing local diagnostic reference levels for mini C-arm use in upper limb surgery – A step towards national audit

et al. 2021

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Radiation exposure of patients during mini C-arm use: an audit in 2032 procedures

Cited by 3 publications

References 7 publications

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

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

Diagnostic Reference Levels for Common Orthopedic Hand and Wrist Procedures Using Intraoperative Mini C-arm Fluoroscopy

Establishing local diagnostic reference levels for mini C-arm use in upper limb surgery – A step towards national audit

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