There Is More to the Story Than Just Fluoroscopy Time: How Patient Position and C-arm Orientation Can Significantly...

To estimate the radiation exposure experienced by members of the surgical team when varying C-arm orientation and patient positions are employed during common approaches to PCNL.

A benchtop experiment was conducted using a Siemens C-arm, standardized dosimetry model (80 kg human torso), and a 180cc ionization chamber (RadCal Accu Gold Touch). Radiation scatter (mR/min) was measured by the healthcare team during common orientations of the C-arm (AP, 15⁰ oblique, lateral) for prone and supine (Bart's free flank 15⁰ decubitus) positions. Exposure was measured using regular and high-dose fluoroscopy, for the OR team for 6 c-arm orientations at eye and gonad level.

Compared with prone position and c-arm in AP, when the c-arm is in lateral orientation, average dose increased 13.6-22.3 times. With dose reduction methods, exposure was reduced 5.9-9.6 times, with surgical team on image intensifier side, and reduced 1.08-7.09 times by rotating C-arm over the table when in the lateral orientation.

Our study has highlighted that alterations in patient and C-arm positioning can increase one's radiation exposure by over 22 times, showing that "total fluoroscopy time" does not provide a full estimate of exposure. This study also highlights the ability for surgical teams to drastically alter radiation exposure by considering positioning as part of the contributing factors.