Patient and surgeon radiation exposure: comparison of standard and mini-C-arm fluoroscopy. 2009

Brian D Giordano, and Judith F Baumhauer, and Thomas L Morgan, and Glenn R Rechtine
Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Box 665, 601 Elmwood Avenue, Rochester, NY 14642, USA.

BACKGROUND Use of c-arm fluoroscopy is common in the operating room, outpatient clinic, and emergency department. Consequently, there is a concern regarding radiation exposure. Mini-c-arm fluoroscopes have gained popularity; however, few studies have quantified exposure during mini-c-arm imaging of a body part larger than a hand or wrist. The purpose of this study was to measure radiation exposure sustained by the patient and surgeon during the use of large and mini-c-arm fluoroscopy of an ankle specimen. METHODS Standard and mini-c-arm fluoroscopes were used to image a cadaver ankle specimen, which was suspended on an adjustable platform. Dosimeters were mounted at specific positions and angulations to detect direct and scatter radiation. Testing was conducted under various scenarios that altered the proximity of the specimen and the radiation source. We attempted to capture a range of exposure data under conditions ranging from a best to a worst-case scenario, as one may encounter in a procedural setting. RESULTS With all configurations tested, measurable exposure during use of the large-c-arm fluoroscope was considerably higher than that during use of the mini-c-arm fluoroscope. Patient and surgeon exposure was notably amplified when the specimen was positioned closer to the x-ray source. The exposure values that we measured during ankle fluoroscopy were consistently higher than the exposure values that have been recorded previously during hand or wrist imaging. CONCLUSIONS Exposure of the patient and surgeon to radiation depends on the tissue density and the shape of the imaged extremity. Elevated exposure levels can be expected when larger body parts are imaged or when the extremity is positioned closer to the x-ray source. When it is possible to satisfactorily image an extremity with use of the mini c-arm, it should be chosen over its larger counterpart.

UI MeSH Term Description Entries
D007432 Intraoperative Period The period during a surgical operation. Intraoperative Periods,Period, Intraoperative,Periods, Intraoperative
D009985 Orthopedics A specialty which utilizes medical, surgical, and physical methods to treat and correct deformities, diseases, and injuries to the skeletal system, its articulations, and associated structures.
D010361 Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clients,Client,Patient
D011829 Radiation Dosage The amount of radiation energy that is deposited in a unit mass of material, such as tissues of plants or animal. In RADIOTHERAPY, radiation dosage is expressed in gray units (Gy). In RADIOLOGIC HEALTH, the dosage is expressed by the product of absorbed dose (Gy) and quality factor (a function of linear energy transfer), and is called radiation dose equivalent in sievert units (Sv). Sievert Units,Dosage, Radiation,Gray Units,Gy Radiation,Sv Radiation Dose Equivalent,Dosages, Radiation,Radiation Dosages,Units, Gray,Units, Sievert
D004867 Equipment Design Methods and patterns of fabricating machines and related hardware. Design, Equipment,Device Design,Medical Device Design,Design, Medical Device,Designs, Medical Device,Device Design, Medical,Device Designs, Medical,Medical Device Designs,Design, Device,Designs, Device,Designs, Equipment,Device Designs,Equipment Designs
D005471 Fluoroscopy Production of an image when x-rays strike a fluorescent screen. Fluoroscopies
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012542 Scattering, Radiation The diversion of RADIATION (thermal, electromagnetic, or nuclear) from its original path as a result of interactions or collisions with atoms, molecules, or larger particles in the atmosphere or other media. (McGraw-Hill Dictionary of Scientific and Technical Terms, 6th ed) Radiation Scattering,Radiation Scatterings,Scatterings, Radiation
D016273 Occupational Exposure The exposure to potentially harmful chemical, physical, or biological agents that occurs as a result of one's occupation. Exposure, Occupational,Exposures, Occupational,Occupational Exposures
D016544 Patient Simulation The use of persons coached to feign symptoms or conditions of real diseases in a life-like manner in order to teach or evaluate medical personnel. Patient Simulations,Simulation, Patient,Simulations, Patient

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