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Updated: Jun 22, 2026
X-ray Dose Reduction through Adaptive Exposure in Fluoroscopic Imaging
Published on: September 11, 2011
Analysis of intraoperative radiation exposure in paediatric orthopaedic and trauma patients: a comparative cohort
Philipp Kriechling1,2, Fabian Luca Meichtry2, Maria Anna Smolle3,4
1Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland philipp.Kriechling@balgrist.ch.
Objective:
To reliably analyse the intraoperative radiation exposure in paediatric orthopaedic trauma surgery (POTS).
Design:
Retrospective, comparative cohort study.
Setting:
Single-centre, academic tertiary referral hospital.
Participants:
2271 surgical cases of 1965 paediatric patients (median age 9 years (IQR, 6 to 12), 41% female) who underwent orthopaedic trauma surgery between 2016 and 2021.
Main Outcome Measures:
Radiation exposure was measured as dose area product (DAP, cGycm2) from intraoperative dose reports and categorised by anatomical region. Subsequently, factors in relation to one preoperative image of the region (rDAP) and in relation to a weight-corrected chest x-ray (rDAP chest) were calculated. Further, effective dose (µSv) was estimated.
Results:
A total of 195 667 x-rays were included in the analysis comprising 1584 (70%) trauma cases and 687 (30%) elective orthopaedic cases. The median DAP measured 30 cGycm2 (IQR, 14 to 59) with a median of 62 (IQR, 34 to 107) exposure events per case. The applied DAP was comparable between trauma cases and elective cases (p=0.4). The rDAP reached 26 (IQR, 8 to 69), with the largest factors for multilevel surgery at the upper extremity, elbow and forearm with factors of 89, 56 and 55, respectively. The rDAP chest was highest for hip, multilevel upper extremity and shoulder with values of 27, 26 and 22. Analysis of effective dose revealed a median exposure of 13 µSv (IQR, 3 to 31) with highest values for spine, hip and shoulder reaching 98 µSv (IQR, 49 to 159), 73 µSv (IQR, 30 to 186) and 56 µSv (23 to 126), respectively.
Conclusion:
The data suggest that intraoperative radiation imaging during POTS exposes paediatric patients to a substantial amount of radiation in comparison to preoperative x-rays. In detail, analysis revealed higher effective doses for all procedures close to the trunk. Particularly concerning were the outliers reaching exponentially higher values. This study highlights the necessity for additional research on intraoperative radiation doses, emphasising the importance of minimising radiation exposure in this vulnerable patient cohort.
Trial Registration:
Cantonal ethics committee of Zurich (BASEC 2022-01486).
