The Effect of Metal Instrumentation on Patient and Surgical Team Scatter Radiation Exposure Using Mini C-Arm in a Simulated Forearm Fracture Fixation Model

Abstract

Introduction:To our knowledge, no studies have studied the effect of metal instrumentation (MI) in the field of fluoroscopy regarding changes in the intensity, direction of scatter, and degree of radiation exposure to the patient and surgical team. The goal of this study was to determine whether the presence of MI increases scatter radiation exposure to the patient and surgical team when using a mini C-arm in the horizontal and vertical positions.Methods:Four trials were conducted using a lamb limb specimen and a mini C-arm to simulate a forearm/wrist fracture fixation scenario. Radiation scatter percentages were measured with the mini C-arm in a vertical and horizontal position with and without the presence of MI (a six-hole 3.5-mm limited-contact dynamic compression plate attached to the specimen with six cortical screws and a self-retaining retractor) using a parallel plate radiation detector.Results:The patient, scrub technician, circulating nurse, and anesthesiologist were exposed to no detectable radiation. In the horizontal position with the presence of MI, there was a 181-fold increase in scatter radiation exposure to the first assistant's eyes (0.016% versus 2.893%, 1.4 × 10−6 Sv/min versus 3.5 × 10−5 Sv/min) and increased exposure to the surgeon's hands compared with the horizontal position with no MI. In the vertical position, the scatter radiation received by the first assistant's eyes increased (zero versus 2.9 × 10−6 Sv/min) with MI present, whereas the only radiation measured for the surgeon was in the right hand which did not change with MI present (2.2 × 10−5 Sv/min).Discussion:MI in the field of fluoroscopy increases scatter radiation exposure to a degree that may place the first assistant's yearly eye exposure in excess of the International Commission on Radiological Protection limit. Surgeons and their assistants should wear lead aprons, thyroid shields, and leaded glasses and minimize the usage of fluoroscopy with MI in the field.

The functional and radiological comparison of the surgical treatment results of forearm diaphyseal fractures in adults treated with open reduction internal fixation and intramedullary locking nail

“…However, in nail applications, ensuring proper rotation and anatomical reduction can be more difficult thanosteosynthesis with plate [4]. Also, exposure to more radiation is one of the disadvantages of nail application [12].…”

Surgical technologists' knowledge and performance about radiation protection in Zahedan educational hospitals. A descriptive-analytical study

“…Of these, the distance from the center of the radiation has the greatest effect on reducing the amount of absorbed radiation. [ 3 13 14 ] An integral component of radiology tests is the use of fluoroscopic ionizing radiation and radiography during some surgical procedures. The use of this type of equipment during surgery causes the operating room personnel to be exposed to ionizing radiation.…”

“…The use of this type of equipment during surgery causes the operating room personnel to be exposed to ionizing radiation. [ 15 16 ] Therefore the risks of exposure to ionizing radiation are a concern for operating room personnel[ 14 ] Operating Room Personnel Due to their specific working conditions, such as restrictions on exit from the room, especially for those wearing sterile gloves and gloves as well as being close to the exposure area, and they are more prone to radiation. [ 10 17 ] As the use of radiology tests in medical centers, including the operating room ward, is increasing, the level of awareness of operating room personnel can be increased.…”