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Updated: Mar 26, 2026
Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
Prospective Assessment of the Oncogenic Risk to Patients From Fluoroscopy During Trauma Surgery
Michael J Beebe1, Peter Jenkins, David L Rothberg
1*Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; Departments of †Orthopaedics, and ‡Radiology, University of Utah Hospitals and Clinics, Salt Lake City, UT.
Objective:
Concern about radiation exposure during surgery has focused on surgeon exposure. However, the patient receives exposure that is more direct and, in surgery about the pelvis and hip, internal pelvic nonskeletal organs often cannot be shielded without obscuring the region of surgical interest. The purpose of this study was to prospectively evaluate patients' radiation exposure during fracture surgery of the acetabulum, pelvic ring, and femur to calculate future cancer incidence (CI).
Design:
Prospective descriptive cohort.
Setting:
Level-1 trauma center.
Patients/Participants:
One hundred eight patients with acetabulum, pelvic, or femur fractures requiring operative repair were prospectively enrolled.
Intervention:
Dosimeters were placed in locations determined for each surgery type by a medical physicist.
Main Outcome Measurements:
Demographics, operative records, and average x-ray emission energy were recorded. Effective dose, specific organ doses, and lifetime CI for a 30-year-old patient were calculated.
Results:
Diagnoses included 27 acetabular fractures, 30 intertrochanteric femur fractures, 26 femoral shafts, and 25 pelvic ring injuries. Patients with pelvic ring injuries received the highest effective dose at 0.91 ± 0.74 mSv. The average lifetime increase in CI, for any cancer type, after pelvic ring fixation is 0.0097% for females and 0.0062% for males. The greatest mean single-organ dose to the ovaries (3.82 ± 3.34 mGy) occurred during pelvic ring surgery, correlating to an increased ovarian cancer risk of 0.0013%. The greatest mean single-organ dose to the prostate (6.81 ± 5.91 mSv) also occurred during pelvic surgery, correlating to increased prostate cancer risk of 0.0024%.
Conclusions:
Fracture surgery to the pelvis and femur is exceptionally fluoroscopy-dependent; however, the radiation exposure incurred represents a relatively small increased risk of future cancer development in patients.
Level Of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
