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Establishing local diagnostic reference levels for common orthopaedic procedures using the mini C-arm fluoroscope
Anna Kropelnicki1, Rosemary Eaton2, Alexandra Adamczyk3
1Specialist Trainee 8, Trauma and Orthopaedic Surgery, The Hillingdon Hospitals NHS Foundation Trust, London, UK.
Objective:
Mini C-arm fluoroscopes are widely used by orthopaedic surgeons for intraoperative image guidance without the need for radiographers. This puts the responsibility for radiation exposure firmly with the operating surgeon. In order to maintain safe and best practice under U.K. Ionising Radiation (Medical Exposure) Regulations, one must limit radiation exposure and audit performance using national diagnostic reference levels (DRLs). In the case of the mini C-arm, there are no national DRLs. IR(ME)R, therefore, require the establishment of local DRLs by each hospital to act as an alternative guideline for safe radiation use. The aim of our audit was to establish local DRLs based on our experience operating with the use of the mini C-arm over the last 7 years.
Methods:
This retrospective audit evaluates the end dose-area product (DAP) recorded for common trauma and orthopaedic procedures using the mini C-arm in a busy district general hospital.We present the quartile data and have set the cut-off point as the third quartile for formulating the local DRLs, consistent with the methodology for the conventional fluoroscope.
Results:
For our data set (n = 1664), the third quartile DAP values were lowest for surgeries to the forearm (5.38 cGycm2), hand (7.62 cGycm2), and foot/ankle (8.56 cGycm2), and highest for wrist (10.64 cGycm2) and elbow (14.61 cGycm2) procedures.
Advances In Knowledge:
To our knowledge, this is the largest data set used to establish local DRLs. Other centres may find our guidelines useful whilst they establish their own local DRLs.
Insights
Orthopaedic surgeons using mini C-arms need local radiation safety guidelines. This study establishes local diagnostic reference levels (DRLs) for mini C-arm use, providing crucial safety benchmarks for radiation exposure in UK hospitals.
Area of Science:
- Medical Physics
- Orthopaedic Surgery
- Radiology
Background:
- Mini C-arm fluoroscopes are essential for intraoperative guidance in orthopaedics, placing radiation safety responsibility on surgeons.
- The UK Ionising Radiation (Medical Exposure) Regulations mandate radiation dose limitation and performance auditing.
- Absence of national diagnostic reference levels (DRLs) for mini C-arms necessitates local guideline establishment.
Purpose of the Study:
- To establish local diagnostic reference levels (DRLs) for mini C-arm fluoroscopy.
- To provide radiation safety guidelines for orthopaedic surgeons in the UK.
- To audit and benchmark radiation exposure from mini C-arm procedures.
Main Methods:
- A retrospective audit of end dose-area product (DAP) was conducted for 1664 trauma and orthopaedic procedures.
- Local DRLs were formulated using the third quartile DAP values, aligning with conventional fluoroscope methodology.
- Data were collected over seven years at a district general hospital.
Main Results:
- The third quartile DAP values varied by anatomical site, with forearm (5.38 cGycm²), hand (7.62 cGycm²), and foot/ankle (8.56 cGycm²) procedures showing the lowest doses.
- Wrist (10.64 cGycm²) and elbow (14.61 cGycm²) procedures exhibited the highest third quartile DAP values.
- This audit represents the largest dataset to date for establishing mini C-arm DRLs.
Conclusions:
- This study provides the largest dataset for establishing local DRLs for mini C-arm use.
- The established local DRLs serve as valuable guidelines for other centres developing their own safety protocols.
- These findings support safe and best practice in radiation management for orthopaedic surgeons.
