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Irradiation level related to intraoperative imaging device in paediatric elastic stable intramedullary nailing:
Marc Prod'homme1, Pierre-Louis Docquier2, Othmane Miri2
1University Hospital of Geneva, Paediatric Orthopaedics, Geneva, Switzerland.
Insights
Intraoperative radiation doses from C-arm imaging during pediatric fracture surgery are low. The study found minimal lifetime cancer risk, suggesting current practices are safe for children undergoing elastic stable intramedullary nailing (ESIN).
Area of Science:
- Pediatric Orthopedics
- Medical Imaging Safety
- Radiation Oncology
Background:
- Radiation exposure from medical imaging, particularly in children, is a significant concern due to increased cancer risk.
- Intraoperative radiation doses from C-arm devices used in pediatric traumatology are not well-documented.
- Assessing these doses is crucial for understanding long-term health implications in young patients.
Purpose of the Study:
- To evaluate intraoperative radiation effective doses (ED) in children undergoing C-arm assisted surgery for long-bone fractures.
- To determine the lifetime attributable risk (LAR) of cancer death associated with this radiation exposure.
- To inform safety protocols and risk-benefit analyses in pediatric orthopedic interventions.
Main Methods:
- A multicenter study prospectively included 51 children requiring elastic stable intramedullary nailing (ESIN) for long-bone fractures.
- Demographic, operative data, and radiation dose reports (duration, doses) were collected.
- Effective dose (ED) was calculated using PCXMC software, and Lifetime Attributable Risk (LAR) was expressed as a percentage.
Main Results:
- The mean effective dose (ED) was 0.085 mSv (SD 0.10), with a range of 0.002 to 0.649 mSv.
- The overall Lifetime Attributable Risk (LAR) was 6.5 x 10^-4% (SD 6.7 x 10^-4%).
- A significant association was found between ED and irradiation time (p < 0.001), but not with other outcomes.
Conclusions:
- Elastic stable intramedullary nailing (ESIN) procedures using C-arm devices in pediatric traumatology result in low effective doses.
- Current intraoperative radiation levels appear to pose a minimal lifetime cancer risk in children.
- Further research with larger sample sizes is recommended to validate these findings.
Purpose:
Radiation-induced cancers due to imaging devices concern above all the growing child, however, to date, intraoperative irradiation doses are not well-documented in children. The goal of the study was to evaluate the intraoperative doses received by patients operated with the use of a C-arm in traumatology, as well as the lifetime attributable risk of cancer death (LAR) related to the irradiation of the imaging device.
Methods:
From 1 April 2017 to 31 March 2019, we started a multicentre study and prospectively recruited all consecutive children who needed elastic stable intramedullary nailing (ESIN) for long-bone fracture. We collected demographic and operative data, with dose reports including duration and doses. The main outcome was the effective dose (ED) in millisievert (mSv), calculated with PCXMC software, and the secondary outcome was the LAR expressed as a percentage.
Results:
In all, 51 patients operated on using 2D C-arm imaging were included in this study. The mean ED was 0.085 mSv (sd 0.10; 0.002 to 0.649). Overall LAR was 6.5 x 10-4% (sd 6.7 x 10-4%; 0.1 x 10-4% to 28.3x10-4%). Univariate linear regression showed a significant association between ED and irradiation time (p < 0.001). There was no significant association between ED and other outcomes (p > 0.05).
Conclusion:
Treatment of long-bone fractures by ESIN found a low level of effective doses with utilization of the C-arm device in current practice. Further studies on a larger sample are needed to confirm these results.
Level Of Evidence:
II.
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