The Effect of Operative Field Instrument Clutter During Intraoperative Fluoroscopy on Radiation Exposure

Hajiha, Mohammad; Smith, J. L.; Amasyalı, Akın S.; Groegler, Jason; Shah, Milan; Alsyouf, Muhannad; Krause, Andrew R.; You, Hyelin; Brown, Jeremy R. Glissen; Li, Ashley; Goyne, Arthur; Baldwin, Danielle; Stokes, Phillip; Hsi, Ryan S.; Baldwin, D. Duane

doi:10.1089/end.2019.0285

Cited by 7 publications

(6 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is likely due to the effect of introducing hyperdense objects, such as radiation-attenuating gloves, into the path of the uoroscopy beam. This has been shown to increase the radiation produced by the machine when it is operating in the AEC setting [14]. On the other hand, the needle holder is made from a low-density material and has a slim contour, which may have allowed the uoroscopy machine to generate a lower radiation dose.…”

Section: Discussionmentioning

confidence: 99%

“…Fluoroscopy was performed using a GE OEC 9900 portable C-arm system (GE Medical system, Inc., Salt Lake City, UT) using the default automatic exposure control (AEC) for all trials. The AEC adjusts the milliampere-seconds (mAs) and peak kilovoltage (kVp) based on the target density to provide optimal image quality [14]. The C-arm was positioned over the right kidney with the X-ray source below the table and the image intensi er above the patient at a skin-to-source distance of 20 cm.…”

Section: Radiation Dose Measurementsmentioning

confidence: 99%

See 1 more Smart Citation

Reducing Hand Radiation during Renal Access for Percutaneous Nephrolithotomy: A Comparison of Radiation Reduction Techniques

Chen,

Joo,

Baas

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

Introduction Percutaneous nephrolithotomy confers the highest radiation to the urologist’s hands compared to other urologic procedures. This study compares radiation exposure to the surgeon’s hand and patient’s body when utilizing three different techniques for needle insertion during renal access. Methods Simulated percutaneous renal access was performed using a cadaveric patient and separate cadaveric forearm representing the surgeon’s hand. Three different needle-holding techniques were compared: conventional glove (control), a radiation-attenuating glove, and a novel needle holder. Five 300-second fluoroscopy trials were performed per treatment arm. The primary outcome was radiation dose (mSv) to the surgeon’s hand. The secondary outcome was radiation dose to the patient. One-way ANOVA and Tukey’s B post-hoc tests were performed with p<0.05 considered significant. Results Compared to the control (3.92 mSv), both the radiation-attenuating glove (2.48 mSv) and the needle holder (1.37 mSv) reduced hand radiation exposure (p<0.001). The needle holder reduced hand radiation compared to the radiation-attenuating glove (p<0.001). The radiation-attenuating glove resulted in greater radiation produced by the C-arm compared to the needle holder (83.49 vs 69.22 mGy; p=0.019). Patient radiation exposure was significantly higher with the radiation-attenuating glove compared to the needle holder (8.43 vs 7.03 mSv; p=0.027). Conclusion Though radiation-attenuating gloves decreased hand radiation dose by 37%, this came at the price of a 3% increase in patient exposure. In contrast, the needle holder reduced exposure to both the surgeon’s hand by 65% and the patient by 14%. Thus, a well-designed low-density needle holder could optimize radiation safety for both surgeon and patient.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Radiation Dose Measurementsmentioning

confidence: 99%

Reducing Hand Radiation during Renal Access for Percutaneous Nephrolithotomy: A Comparison of Radiation Reduction Techniques

Chen,

Joo,

Baas

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Fluoroscopy was performed using a GE OEC 9900 portable C-arm system (GE Medical system, Inc., Salt Lake City, UT) using the default automatic exposure control (AEC) for all trials. The AEC adjusts the milliampere-seconds (mAs) and peak kilovoltage (kVp) based on the target density to provide optimal image quality [ 14 ]. The C-arm was positioned over the right kidney with the X-ray source below the table and the image intensifier above the patient at a skin-to-source distance of 20 cm.…”

Section: Methodsmentioning

confidence: 99%

Reducing hand radiation during renal access for percutaneous nephrolithotomy: a comparison of radiation reduction techniques

Chen,

Joo,

Baas

et al. 2024

Urolithiasis

Self Cite

View full text Add to dashboard Cite

Percutaneous nephrolithotomy confers the highest radiation to the urologist’s hands compared to other urologic procedures. This study compares radiation exposure to the surgeon’s hand and patient’s body when utilizing three different techniques for needle insertion during renal access. Simulated percutaneous renal access was performed using a cadaveric patient and separate cadaveric forearm representing the surgeon’s hand. Three different needle-holding techniques were compared: conventional glove (control), a radiation-attenuating glove, and a novel needle holder. Five 300-s fluoroscopy trials were performed per treatment arm. The primary outcome was radiation dose (mSv) to the surgeon’s hand. The secondary outcome was radiation dose to the patient. One-way ANOVA and Tukey’s B post-hoc tests were performed with p < 0.05 considered significant. Compared to the control (3.92 mSv), both the radiation-attenuating glove (2.48 mSv) and the needle holder (1.37 mSv) reduced hand radiation exposure (p < 0.001). The needle holder reduced hand radiation compared to the radiation-attenuating glove (p < 0.001). The radiation-attenuating glove resulted in greater radiation produced by the C-arm compared to the needle holder (83.49 vs 69.22 mGy; p = 0.019). Patient radiation exposure was significantly higher with the radiation-attenuating glove compared to the needle holder (8.43 vs 7.03 mSv; p = 0.027). Though radiation-attenuating gloves decreased hand radiation dose by 37%, this came at the price of a 3% increase in patient exposure. In contrast, the needle holder reduced exposure to both the surgeon’s hand by 65% and the patient by 14%. Thus, a well-designed low-density needle holder could optimize radiation safety for both surgeon and patient.

show abstract

“…56,57 Modern fluoroscopy systems help to reduce radiation dose by automatic adjustment of dosage (automatic brightness control; ABC) and there are functions to save the last image. 58 When ABC is being used, one should avoid putting radio-opaque objects inside the beam as this will cause an automatic increase in radiation dose. One study demonstrated that when radio-opaque objects including lateral operating table support, endoscopy cameras, light cords and flexible ureteroscopy is placed inside the field, the C-arm radiation dose increases by 35%.…”

Section: X-ray Positioning and Modesmentioning

confidence: 99%

“…One study demonstrated that when radio-opaque objects including lateral operating table support, endoscopy cameras, light cords and flexible ureteroscopy is placed inside the field, the C-arm radiation dose increases by 35%. 58 The physicians and assistants should pay attention to clear clutters of instruments and objects on the operating table. Fluoroscopy settings also help reduce the radiation hazard.…”

Section: X-ray Positioning and Modesmentioning

confidence: 99%

Occupational hazard of fluoroscopy: An invisible threat to orthopaedic surgeons

Wan

Chau

Tso

et al. 2021

Journal of Orthopaedics, Trauma and Rehabilitation

View full text Add to dashboard Cite

The use of fluoroscopy is widespread within different medical specialties. Improper protection may cause significant radiation hazard to medical personnel. To evaluate the concepts on radiation safety and fluoroscopy use among orthopaedic surgeons and to reflect our current training on this issue, a survey was distributed to perform an audit in our department, an academic unit. Twenty-eight orthopaedic surgeons replied. Amongst our participants, 96.4% used a lead apron at all times. Only 33% used a thyroid shield, 67% never used radiation goggles and 96% never used radiation protection gloves. 53.6% and 46.4% of participants position the fluoroscopy incorrectly in the anteroposterior and lateral positions, respectively, during use. There is clearly a need for improved safety amongst orthopaedic surgeons. A literature review was further performed, showing the hazards of fluoroscopy for doctors, including the risk of cataracts, radiation dermatitis, skin cancer and thyroid cancer. Hazards specific to females, including breast cancer risk, and in-utero irradiation of foetus were also thoroughly discussed. Recommendations towards radiation safety and practical measures to reduce fluoroscopy radiation hazard during procedure were made. Education and training to doctors on this invisible hazard is strongly advised.

show abstract

The Effect of Operative Field Instrument Clutter During Intraoperative Fluoroscopy on Radiation Exposure

Cited by 7 publications

References 22 publications

Reducing Hand Radiation during Renal Access for Percutaneous Nephrolithotomy: A Comparison of Radiation Reduction Techniques

Reducing Hand Radiation during Renal Access for Percutaneous Nephrolithotomy: A Comparison of Radiation Reduction Techniques

Reducing hand radiation during renal access for percutaneous nephrolithotomy: a comparison of radiation reduction techniques

Occupational hazard of fluoroscopy: An invisible threat to orthopaedic surgeons

Contact Info

Product

Resources

About