The Comparison of the Effectiveness of Angle-Measured Fluoroscopy Imaging Method with the Traditional Method in...

The effectiveness of a shooting method based on patient and fluoroscopy positioning to reduce the number of shots and radiation exposure in posterior pelvic injuries characterized by sacroiliac joint disruption was investigated.

Patients who underwent intraoperative pelvic radiological imaging or percutaneous sacroiliac screw application due to sacral fracture, sacroiliac instability, dislocation, or pelvic instability between 2017 and 2023 were included. A total of 40 patients (17 male, 23 female) were randomly selected and distributed equally into two groups (Group 1: traditional method, Group 2: angle-measured method) by the first author. Each group consisted of 20 patients, and imaging was performed by two different fluoroscopy technicians (Technician A and Technician B), with 10 patients per group examined by each technician. Coccyx lateral, pelvic inlet, and pelvic outlet radiographs were obtained in both groups. The number of shots required to obtain diagnostically adequate images was recorded and compared.

In Group 1 shots, Technician A obtained suitable images with the following number of shots: Coccyx lateral 12.3 ± 3.2 (range 7-18); pelvic inlet 10.8 ± 2.4 (range 6-16); pelvic outlet 12.5 ± 2.8 (range 7-17). Technician B obtained: Coccyx lateral 12.8 ± 1.5 (range 10-16); pelvic inlet 12.2 ± 3.1 (range 6-18); pelvic outlet 14.5 ± 2.7 (range 10-18). In Group 2 shots, Technician A obtained: Coccyx lateral 3.5 ± 1.4 (range 1-7); pelvic inlet 3.8 ± 1.8 (range 1-9); pelvic outlet 4.3 ± 1.7 (range 2-7). Technician B obtained: Coccyx lateral 3.1 ± 1.07 (range 1-5); pelvic inlet 4.1 ± 1.4 (range 2-7); pelvic outlet 5.9 ± 2.2 (range 3-10). Statistically significant differences were observed in the number of shots for coccyx lateral (p < 0.001, f: 365.8, df: 1), pelvic inlet (p < 0.001, f: 227.7, df: 1), and pelvic outlet (p < 0.001, f: 270.6, df: 1) images between Group 1 and Group 2.

Preoperative patient positioning and proper fluoroscopy positioning according to the lateral sacral tilt angle significantly affected the number of shots and the quality of the obtained images. The angle-measured method required fewer shots and reduced radiation exposure during posterior pelvic surgical procedures.