Radiation Reduction in Low Dose Pulsed Fluoroscopy versus Standard Dose Continuous Fluoroscopy during Fluoroscopically-Guided Lumbar Punctures: A Prospective Controlled Study

Sabat, Shyam; Slonimsky, Einat

doi:10.4103/jcis.jcis_94_17

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…It has been shown in numerous previous studies that pulsed fluoroscopy can significantly reduce overall radiation exposure, and this could be an area for improved surgical education. 27,28 In a prior study by Striano et al, 29 surgeon experience did not improve operative time or decrease costs associated with supracondylar humerus fractures. In conjunction with this study, a possible conclusion can be drawn that surgeons are being better prepared for working efficiently than working safely.…”

Section: Discussionmentioning

confidence: 89%

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Does Surgical Experience Decrease Radiation Exposure in the Operating Room?

Magee¹,

Karkenny²,

Nguyen

et al. 2021

Journal of Pediatric Orthopaedics

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Background: Intraoperative fluoroscopy facilitates minimally invasive surgery, and although it is irreplaceable in terms of intraoperative guidance, it results in substantial radiation exposure to the patient and surgical team. Although the risk of radiation exposure because of equipment factors has been described, there is little known about the impact of surgeon experience on radiation exposure. The aim of this study was to determine whether there is a relationship between years of surgical experience and total dose of radiation used for an archetypal pediatric orthopaedic surgical procedure that requires intraoperative fluoroscopy. Methods: This was a retrospective cohort study of children undergoing closed reduction and percutaneous pinning for supracondylar humerus fractures at a level I pediatric trauma center. Information pertaining to radiation dosage was gathered including fluoroscopic time, total images acquired, magnification use, and dose area product (DAP). Regression analysis was used to evaluate the effect of surgeon experience on the outcome variables. Results: A total of 759 pediatric patients treated by 17 attending surgeons were included. The median surgeon experience was 8.94 years (interquartile range, 5.9 to 19.8). Increased number of pins was associated with increased DAP (P < 0.001) and lower years of experience (P = 0.025). There was significantly higher fluoroscopy time in seconds (56.9 vs. 42.1 s, P = 0.001), DAP (179.9 vs. 110.3 mGy-cm 2 , P = 0.001), use of magnification (39.5 vs. 31.9 s, P = 0.043), and total number of images obtained (74.5 vs. 57.6, P = 0.008) in attending surgeons with <1 year of experience compared with those with greater experience. An operator extremity was visible in at least 1 saved image in 263 of 759 (35%) cases. Conclusion: Increased surgical experience was significantly associated with decreased fluoroscopy usage, including time, number of images, and dose. Surgeon inexperience increases radiation exposure for patients and staff by over 60% when treating supracondylar humerus fractures. This study clearly identifies methods to reduce radiation exposure, including use of pulsed fluoroscopy instead of continuous fluoroscopy, decreasing use of magnification, removing the operator's extremity from the field, and judicious use and placement of each additional pin. Level of Evidence: Level III.

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Section: Discussionmentioning

confidence: 89%

“…Notably, no surgeon with ≤1 year of experience used pulsed fluoroscopy at all. It has been shown in numerous previous studies that pulsed fluoroscopy can significantly reduce overall radiation exposure, and this could be an area for improved surgical education 27,28…”

Section: Discussionmentioning

confidence: 99%

Does Surgical Experience Decrease Radiation Exposure in the Operating Room?

Magee¹,

Karkenny²,

Nguyen

et al. 2021

Journal of Pediatric Orthopaedics

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“…Our findings further add to the results of previous studies that have evaluated and advocated for the use of low-dose pulsed fluoroscopy in other radiological procedures. Sabat et al evaluated low-dose pulsed fluoroscopy versus standard-dose continuous fluoroscopy during fluoroscopically-guided lumbar punctures and found low-dose pulsed fluoroscopy significantly reduces radiation exposure by about 600% compared with standard-dose continuous fluoroscopy, thus dramatically reducing radiation exposure without impacting the image quality or technical success rate [36]. Similarly, Badawy et al evaluated the utilization of ultra-low pulse rate fluoroscopy in routine transfemoral diagnostic coronary angiography and found no reduction of diagnostic clarity, no increase in fluoroscopy time, and up to a 58 percent reduction in Dose Area Product (DAP) [37].…”

Section: Discussionmentioning

confidence: 99%

Low-dose pulsed vs standard pulsed fluoroscopy during ERCP to reduce radiation without change in image quality: Prospective randomized study

Ali,

Kesar,

Alizadeh

et al. 2024

Endosc Int Open

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) poses the risk of radiation exposure (RE) to patients and staff, and increases the risk of adverse biological effects such as cataracts, sterility, and cancer. Newer fluoroscopy equipment (C-Arm) provides options to limit radiation in the form of lower radiation dose and frame rate or time-limited “pulsed” settings. However, the impact of lower settings on image quality has not been assessed, and no standard protocol for fluoroscopy settings used during ERCP exist. Methods: A single-center, double-blind, prospective randomized study of consecutive adult patients undergoing standard-of-care ERCP at a tertiary academic medical center. Patients were randomized into two groups: 1) standard-dose pulsed; 2) low-dose pulsed. Pulsed mode (8 fps) was defined as x-ray exposure either in the manufacturer standard-dose or low-dose settings limited to 3 seconds each time the foot-operated switch is depressed. Results: Seventy-eight patients undergoing ERCP were enrolled and randomized. No difference in age, gender, and BMI was found between the two groups. No significant difference in image quality was found between standard-dose and low-dose fluoroscopy (p=0.925). The low-dose group was exposed to significantly less radiation when compared to standard-dose (p < 0.05). Fluoroscopy time (minutes) was similar in both groups (2.0 vs 1.9), further suggesting that group assignment had no impact on image quality or procedure time. Conclusions: Low-dose pulsed fluoroscopy is a reliable method that substantially reduces radiation without compromising image quality or affecting procedural or fluoroscopy times. This highlights the need for standardization in ERCP fluoroscopy settings to limit radiation exposure.

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