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

Published on Aug 1, 2009in Journal of Bone and Joint Surgery, American Volume4.578
· DOI :10.2106/JBJS.H.00407
Brian D. Giordano16
Estimated H-index: 16
(URMC: University of Rochester Medical Center),
Judith F. Baumhauer39
Estimated H-index: 39
(URMC: University of Rochester Medical Center)
+ 1 AuthorsGlenn R. Rechtine30
Estimated H-index: 30
(URMC: University of Rochester Medical Center)
Sources
Abstract
To The Editor: We read with much interest the recent article “Patient and Surgeon Radiation Exposure: Comparison of Standard and Mini-C-Arm Fluoroscopy” (2009;91:297-304) by Giordano et al. It addressed an important issue arising from the increasing use of radiographic imaging in medicine. Although the authors correctly concluded that protective safety measures should be enforced when using intraoperative fluoroscopy, it might be useful to the reader to have a more complete understanding about …
📖 Papers frequently viewed together
69 Citations
78 Citations
62 Citations
References34
Newest
#1Brian D. Giordano (URMC: University of Rochester Medical Center)H-Index: 16
#2Judith F. BaumhauerH-Index: 39
Last. Glenn R. RechtineH-Index: 30
view all 4 authors...
Study Design.A cadaveric cervical spine specimen is imaged with a standard C-arm fluoroscope during a simulated procedure. Patient and surgeon exposure to radiation is estimated by placing dosimeters at various locations in 3-dimensional space.Objective.The purpose of this study was to evaluate radi
58 CitationsSource
#1Amer ShoaibH-Index: 2
#2Ulfin RethnamH-Index: 10
Last. Nilesh MakwanaH-Index: 12
view all 5 authors...
Background: The mini C arm is a mobile fluoroscopic device for use on extremities. It has been reported that this type of device has several advantages over a conventional C arm, the most important of which is a decreased level of radiation scatter to the surgeon. Methods: This was a case control study. The radiation dose to the surgeon was calculated from the radiation exposure time and distance from the x-ray emitter. Cases using the mini C arm were compared with operation-matched controls tha...
34 CitationsSource
To The Editor: We commend Giordano et al. on their excellent work in quantifying the risk of radiation when using a mini-C-arm fluoroscopy unit, as reported in their study entitled “Exposure to Direct and Scatter Radiation with Use of Mini-C-Arm Fluoroscopy” (2007;89:948-52). Their methodology, however, does not accommodate for the measurement of increased radiation exposure when the C-arm is used in the conventional method, with the image …
8 CitationsSource
#1Kim A. Lopez (CUMC: Columbia University Medical Center)H-Index: 5
#2Allen Waziri (CUMC: Columbia University Medical Center)H-Index: 23
Last. Sean D. Lavine (CUMC: Columbia University Medical Center)H-Index: 28
view all 8 authors...
OBJECTIVE: The routine use of intraoperative angiography (IA) is still surrounded by controversy. We prospectively performed lAs in consecutive patients undergoing surgery for aneurysms, arteriovenous malformations, and dural arteriovenous fistulae. We calculated the percentage of identified residual pathologies, the cases requiring further surgical intervention, and the complication rates associated with the procedure. We also recorded radiation dose received by personnel during IA for comparis...
19 CitationsSource
#1Pei Ho (Queen Mary Hospital)H-Index: 26
#2Stephen W.K. Cheng (Queen Mary Hospital)H-Index: 36
Last. M.S. Tsang (Hong Kong Department of Health)H-Index: 1
view all 8 authors...
Objective Endovascular procedures have become an integral part of a vascular surgeon’s practice. The exposure of surgeons to ionizing radiation and other safety issues have not been well studied. We investigated the radiation exposure of a team of vascular surgeons in an active endovascular unit and compared yearly dosages absorbed by various body parts among different surgeons. Patients’ radiation exposure was also assessed. Methods The radiation absorption of a team of vascular surgeons was pr...
68 CitationsSource
#2Virginia TsapakiH-Index: 21
Last. George Papachristou (UoA: National and Kapodistrian University of Athens)H-Index: 11
view all 7 authors...
In this study, a mathematical method was used to estimate the entrance surface dose (ESD) to the patient and the scattered dose (Ds) to the operating surgeon during various fluoroscopically guided surgical orthopaedic procedures. For 204 patients, the procedure type, the fluoroscopy time and the highest tube potential and current values observed during fluoroscopy were recorded. For the most often performed procedures (intramedullary nailing of peritrochanteric fractures, open reduction and inte...
69 CitationsSource
#1Brian D. Giordano (URMC: University of Rochester Medical Center)H-Index: 16
#2Steven Ryder (URMC: University of Rochester Medical Center)H-Index: 2
Last. Benedict F. DiGiovanni (URMC: University of Rochester Medical Center)H-Index: 20
view all 4 authors...
Background: Mini-c-arm fluoroscopy has become an important resource to the orthopaedic surgeon. Exposure of the orthopaedic surgical team to radiation during standard large-c-arm fluoroscopy has been well studied; however, little is known about the amount of exposure to which a surgical team is subjected with the use of mini-c-arm fluoroscopy. Moreover, there is controversy regarding the use of protective measures with mini-c-arm fluoroscopy. Methods: We evaluated the use of mini-c-arm fluorosco...
69 CitationsSource
#1Thomas H. Frazier (University of Louisville)H-Index: 9
Last. Jeffrey P. CallenH-Index: 66
view all 4 authors...
Background Fluoroscopy-induced chronic radiation dermatitis (FICRD) resulting from prolonged exposure to ionizing radiation during interventional procedures has been documented in the radiology and cardiology literature. However, the phenomenon has been rarely reported in the dermatologic literature. Since patients with FICRD often see a dermatologist or a primary care physician to treat their injuries, the diagnosis of FICRD is perhaps often overlooked. Observations A 62-year-old man with type ...
63 CitationsSource
INTRODUCTIONThe quality and quantity of information required in the consent process is well documented, but there is little extant literature regarding timing of either information about the proposed procedure or the act of consent itself. With the recent introduction of a new NHS-wide consent form, we wished to determine the preferences of both patients and staff to ascertain whether any concordance of views existed. PATIENTS AND METHODSA 10-point questionnaire, developed in conjunction with th...
20 CitationsSource
INTRODUCTIONImage intensifier screening is commonly used in orthopaedic theatres. There has been concern regarding the cumulative radiation dose to surgeons and theatre personnel. The mini C-arm intensifier has been reported to scatter less radiation and have a reduced radiation dose to patients and theatre staff. MATERIALS AND METHODSA 2-month prospective survey of usage of radiographer-operated large intensifier and surgeon-operated mini C-arm image intensifier in a district general hospital o...
12 CitationsSource
Cited By80
Newest
Source
Last. Pedro José Labronici (Federal Fluminense University)H-Index: 8
view all 3 authors...
Source
#1A. A. Chatzis (UWest: University of the West)
Last. Sotiris Soulis (UWest: University of the West)H-Index: 1
view all 8 authors...
Abstract Introduction The use of fluoroscopy-assisted surgical procedures has been increasing recently. The extensive use of fluoroscopy, combined with the lack of knowledge about radiation risks among operating room (OR) personnel (surgeons, anaesthetists, nurses, and radiographers), may lead to misconceptions. The perceptions and beliefs of any health professional concerning radiation protection safety (RPS) may affect their behaviour during surgery, leading to negative outcomes. The aim of th...
Source
#1Mohsen Raza (St George’s University Hospitals NHS Foundation Trust)H-Index: 2
#2James Houston (St George’s University Hospitals NHS Foundation Trust)H-Index: 1
Last. Alex Trompeter (St George’s University Hospitals NHS Foundation Trust)H-Index: 10
view all 5 authors...
The use of ionising radiation for plain film radiography and computerised tomography is fundamental in both diagnostics and treatment for orthopaedics. However, radiation is not without risk as high exposure can increase the risk of cancer. Little time is spent educating doctors about the relative risks of radiation, both to patients and themselves. In addition, there are common misunderstandings about the best ways to mitigate such risk. We aim to provide an overview of the fundamental principl...
1 CitationsSource
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 strat...
Source
#1Guy Guenthner (UMN: University of Minnesota)
#2Alexander Eddy (UMN: University of Minnesota)
Last. Christopher Martin (UMN: University of Minnesota)H-Index: 118
view all 5 authors...
BACKGROUND: Intraoperative three-dimensional (3D) computed tomography (CT) imaging has become increasingly popular in spine surgery. Previous spine surgeon radiation exposure research has focused largely on procedures using fluoroscopy, however, few studies have been performed on the subject since the introduction of the 3D imaging systems. As a result, concerns have re-emerged over surgeon radiation exposure and the effectiveness of operating room (OR) protocols for decreasing workplace radiati...
2 CitationsSource
Source
Abstract We have assessed chromosome-type aberrations and micronuclei in the peripheral lymphocytes of personnel working with C-arm fluoroscopy, multi-slice CT-scan, lithotripsy, and digital radiology medical procedures. The study population comprised of 46 exposed workers and 35 controls matched for age, gender, and other confounding factors. Chromosome-type aberrations and micronuclei were analyzed and compared with occupational dosimetry data. The highest frequency of both chromosome aberrati...
3 CitationsSource
#2Willy A. HummelH-Index: 2
Last. Chantal M. MouësH-Index: 3
view all 4 authors...
Background: The use of intraoperative fluoroscopy has become mandatory in osseous hand surgery. Due to its overall practicality, the mini C-arm has gained popularity among hand surgeons over the st...
1 CitationsSource
#2T. B. BaltrukovaH-Index: 1
Last. M. D. PetrovaH-Index: 1
view all 4 authors...
2 CitationsSource