A Comparison of Image Quality and Radiation Exposure Between the Mini C-Arm and the Standard C-Arm

Rappard, Juliaan R.M. van; Hummel, Willy A.; Jong, Tijmen de; Mouës, Chantal M.

doi:10.1177/1558944718770210

Cited by 6 publications

(3 citation statements)

References 15 publications

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“…Singer et al 19 used a cadaveric setup to measure direct patient radiation exposure and found that exposure using the mini c-arm was 53% to 70% greater than that using the conventional c-arm. Similarly, van Rappard et al 20 reported that, although image quality was significantly improved with the mini c-arm, the patients' entrance dose was 10 times higher for the mini c-arm as compared with its conventional counterpart. Conversely, the mini c-arm was found to be associated with a statistically significant reduction in DAP in foot and ankle surgery 21 as well as a reduction in occupational exposure to the surgeon and operating room staff in a cadaveric wrist model 22 .…”

Section: Discussionmentioning

confidence: 92%

Investigating Patient-Level Radiation Exposure in Hand and Wrist Fracture Surgery

Christopher

Hu³

et al. 2022

Ann Plast Surg

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Background Although occupational exposure to radiation has been previously studied in the hand surgery literature, there is a paucity of studies looking at radiation exposure to the patient during fluoroscopy-guided hand surgery. We aimed to describe the level of radiation experienced by patients undergoing common hand and wrist fracture fixation and to identify risk factors for increased radiation exposure. Methods We performed a retrospective review of patients at a single institution who underwent fracture fixation of the hand, wrist, or forearm requiring mini c-arm fluoroscopic guidance from 2016 to 2020. Data points collected included patient demographics, procedural details, and indicators of radiation exposure including dose-area product (DAP), total intraoperative images, and total fluoroscopy time. Effective dose (ED) was calculated using DAP, field size, and a previously established conversion factor. Results The final sample included 361 patients with an average age of 46 years. Procedures included fixation of forearm fractures (3.3%), distal radius fractures (35.7%), metacarpal fractures (30.8%), and phalangeal fractures (30.2%). The median number of intraoperative images acquired was 36, median total fluoroscopy time was 43 seconds, median DAP was 4.8 cGycm2, and median ED was 0.13 μSv. Distal (metacarpal and phalangeal) fractures required more intraoperative images and longer total fluoroscopy time (49 images, 61 seconds) compared with proximal (forearm and distal radius) fractures (39 images, 47 seconds) (images, P = 0.004; exposure time, P = 0.004). However, distal fractures had a lower average ED compared with proximal fractures (0.15 vs 0.19 μSv, P = 0.020). When compared with open procedures, percutaneous procedures had higher DAPs (8.8 vs 4.9 cGycm2, P < 0.001), higher ED (0.22 vs 0.15 μSv, P < 0.001), more intraoperative images (65 vs 36 images, P < 0.001), and longer total fluoroscopy time (81.9 vs 44.4 seconds, P < 0.001). Conclusions Patient-level radiation exposure during fluoroscopy-guided hand and wrist procedures is low relative to other common imaging modalities, such as dental radiographs, chest x-rays, and computed tomography scans, and is comparable with less than a few hours of natural background radiation exposure, highlighting the overall safety of this important technology. Further study should be performed to establish reference ranges, which could lead to improved patient counseling and evidence-based guidelines on patient shielding.

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Section: Discussionmentioning

confidence: 92%

Investigating Patient-Level Radiation Exposure in Hand and Wrist Fracture Surgery

Christopher

Hu³

et al. 2022

Ann Plast Surg

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“…Gieroba TJ et al demonstrated that since the surgeon can easily operate mini C-arm without a radiographer, it reduces surgery delays and saves about 4 minutes of operation time per surgery (15). Although the mini C-arm fluoroscopy device has been promoted mainly due to its easy mobility, decreased cost, and its usage in taking images from smaller parts of the body in the operation room or emergency department (16,17), recently van Rappard JRM et al indicated that the image quality is significantly better for the mini C-arm in comparison with the standard C-arm in hand surgeries (18).…”

Section: Physical Aspectmentioning

confidence: 99%

Challenges of Using C-Arm Fluoroscopy Systems: A Mixed Method Study Investigating Orthopedic Surgeons’ Experience

Gharib,

Mohammadi,

Mohammadi

et al. 2024

JIMC

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Background: Intraoperative fluoroscopy systems are widely used nowadays, where their use allows a shorter duration of procedure time and better anatomical localization. The current study aims to investigate the most common challenges of C-arm fluoroscopy systems application. Methods: This mixed-method study was carried out in February and March 2022. After the literature review, a qualitative study was designed using semi-structured interviews to find important themes and subthemes required to design a web survey. The web survey was completed by the Persian Orthopedic Trauma Association (POTA) event’s international presenters. Results: Nine orthopedic surgeons participated in interviews and 27 participants filled out the questionnaires. Five main themes including Physical Aspect, Mechanical Aspect, Software Options, Image Quality, and Radiation Exposure were extracted. Generally, over 80% of the web survey participants agreed that the size and shape of the base of C-arm fluoroscopy systems, C-arm diameter (space between tube and detector), and maneuvering and positioning of the C-arm fluoroscopy systems can interfere with surgical procedures. 100% of the participants agreed that providing two different views (e.g., AP and lateral) from the surgical site with one shot can be beneficial. The effectiveness of real-time visualization of radiation exposure on exposure rate was acknowledged by more than 92% of the participants. Conclusion: Although the C-arm fluoroscopy systems are widely used in surgical procedures, there are considerable issues regarding the application of this imaging modality in the operation room, and medical equipment companies should pay more attention to these issues to facilitate the use of these systems.

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“…It is a commonly used surgical auxiliary tool in clinical orthopedics. The main uses include assisting in fracture reduction and xation during orthopedic surgery, assisting in implanting a pacemaker, assisting in extracting foreign bodies from the body, assisting in part of angiography and interventional operations, cooperating with an ozone machine to treat pain, cooperating with small needle-knife treatment, assisting gynecological tubal guidance surgery, and so forth [2][3][4][5][6]. It has the advantages of low infection risk, small footprint, and easy movement.…”

Section: Introductionmentioning

confidence: 99%

Development and experimental verification of C-arm camera shooting locator

Yang¹,

Yang

Jon

et al. 2022

Preprint

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Objective: This study aimed to develop a self-made C-arm camera shooting locator and verify its accuracy and advantages. Methods: A total of 60 physicians and nurses from the Surgical System of Sanmen People's Hospital, Zhejiang Province, China, were randomly selected as filming operators. The C-arm machine with a self-made locator and a C-arm machine without a locator were used to measure the center of the circular plate. The iron nails were used to shoot. The distance between the iron nail and the center point of the circular display area on display was defined as the shooting deviation. When it was less than 3 cm, the shooting was stopped. The number of shots, total shooting time, and first-shot deviation in the C-arm camera shooting groups with and without the locator were statistically analyzed, and the advantages and disadvantages of the two were compared. Results: The average number of shots, average total shooting time, and average first-shot deviation of the C-arm camera using the locator were significantly better than those in the group without the locator, and the differences were statistically significant. When the shooting distance (X) was equal to 30 cm and the shooting angle (Y) was equal to 0°, the average number of shots, average total shooting time, and average first-shot deviation were optimal. Conclusions: The C-arm camera shooting locator can improve the shooting accuracy of the C-arm camera and effectively reduce the number of shots and total shooting time. Hence, it can be applied in clinical and surgical practice.

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A Comparison of Image Quality and Radiation Exposure Between the Mini C-Arm and the Standard C-Arm

Cited by 6 publications

References 15 publications

Investigating Patient-Level Radiation Exposure in Hand and Wrist Fracture Surgery

Investigating Patient-Level Radiation Exposure in Hand and Wrist Fracture Surgery

Challenges of Using C-Arm Fluoroscopy Systems: A Mixed Method Study Investigating Orthopedic Surgeons’ Experience

Development and experimental verification of C-arm camera shooting locator

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