Cumulative Radiation Exposure to Patients Undergoing Arthroscopic Hip Preservation Surgery and Occupational Radiation Exposure to the Surgical Team

Canham, Colin D.; Williams, Richard; Schiffman, Scott; Weinberg, Eric; Giordano, Brian D.

doi:10.1016/j.arthro.2015.01.017

Cited by 19 publications

(31 citation statements)

References 35 publications

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“…Nevertheless, the mean BMI of our sample is comparable to that reported by Canham et al 4 The discrepancy between the average annual radiation dose found in the present study and that of Canham et al 4 may be explained by differences in the distance of the operative surgeon from the x-ray source, as this appears to be a major determinant of radiation exposure dose as noted in the trauma literature cited above. It is also important to note that in the study by Canham et al, 4 automatic measurements of radiation exposure were generated by the fluoroscopy unit and dose calculations were performed by a radiologist. 4 Therefore, variability in the aforementioned factors may explain the discrepancy between our results and those of Canham et al 4 …”

Section: Discussionsupporting

confidence: 62%

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Intraoperative Radiation Exposure During Hip Arthroscopy

Salvo

Zarah

Chaudhry

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:The frequency of hip arthroscopy for the treatment of acute and chronic chondrolabral pathology and femoroacetabular impingement (FAI) has increased exponentially over the past decade. While surgeon and patient radiation exposure has been well documented in other areas of the orthopaedic literature, little is known about the procedure-specific and cumulative doses affecting the hip arthroscopist.Purpose:To determine the mean annual radiation exposure to the hip arthroscopist and the mean surgeon exposure per case.Study Design:Case series; Level of evidence, 4.Methods:A total of 210 consecutive hip arthroscopies performed in 209 patients by a single surgeon at a single ambulatory surgical center in a cohort consisting of approximately 50% bony (cam and pincer) pathology were prospectively reviewed, documenting the specific procedures performed in each case and the readings from a radiation dosimeter worn by the surgeon during positioning and while performing the procedures. Radiation readings for deep dose–equivalent (DDE), lens dose–equivalent (LDE), and shallow dose–equivalent (SDE) were measured. These readings were compared with the annual radiation dose limit recommendations established by the International Commission on Radiological Protection (ICRP).Results:The total radiation doses for the operative surgeon during all 210 cases were 183 mrem (1.83 mSv) DDE, 183 mrem (1.83 mSv) LDE, and 176 mrem (1.76 mSv) SDE. The mean exposure per case was 0.871 mrem (0.00871 mSv) DDE, 0.871 mrem (0.00871 mSv) LDE, and 0.838 mrem (0.00838 mSv) SDE. The operative surgeon’s mean annual exposure, performing 70 hip arthroscopies per year with 55% involving bony work, was 61.0 mrem (0.610 mSv) DDE, 61.0 mrem (0.610 mSv) LDE, and 58.7 mrem (0.587 mSv) SDE. These results are well below the ICRP annual limits of 50,000 mrem (500 mSv) DDE, 2000 mrem (20 mSv) LDE, and 50,000 mrem (500 mSv) SDE.Conclusion:For an experienced hip arthroscopist utilizing fluoroscopy during setup and bony resection, the annual and per-patient exposure to radiation remains well below the recommended ICRP limits.Clinical Relevance:Considering the increasing annual frequency of hip arthroscopies being performed, information regarding procedure-specific and cumulative doses of radiation exposure affecting the hip arthroscopist may provide valuable safety information for the orthopaedic community.

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Section: Discussionsupporting

confidence: 62%

“…It is also important to note that in the study by Canham et al, 4 automatic measurements of radiation exposure were generated by the fluoroscopy unit and dose calculations were performed by a radiologist. 4 Therefore, variability in the aforementioned factors may explain the discrepancy between our results and those of Canham et al 4 …”

Section: Discussionmentioning

confidence: 99%

Intraoperative Radiation Exposure During Hip Arthroscopy

Salvo

Zarah

Chaudhry

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…Although research would suggest that exposure often falls below current recommended limits, additional efforts could be made to minimize exposure. 9 , 10 In addition, the physical impact of protective garments (lead aprons, etc.) merits consideration.…”

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confidence: 99%

Is There a Role for Ultrasound in Hip Arthroscopy? A Systematic Review

Williams

Vadhera

Maheshwer

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose The purpose of this study is to identify and summarize the current utility of intraoperative ultrasound (US) during hip arthroscopy. Methods A systematic database query of the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, EMBASE, PubMed (1980 to 2019), and Ovid MEDLINE (1980 to 2019) was performed. After article identification, descriptions of the surgical procedure, use of intraoperative US, procedural complications, and conclusions from each article were recorded and summarized. Results Five studies met inclusion criteria, all of which were surgical techniques or technical notes. Four of the 5 studies described US used for placement of arthroscopic portals, and 1 described the use of an intraarticular US catheter for the assessment of an osteochondritis dissecans (OCD) lesion. Of the 4 studies using US for portal placement, 3 were performed supine and 1 was performed in the lateral decubitus position. All studies recognized the need for additional US training or the required assistance of a radiologist to incorporate US into a surgical practice. Conclusion Descriptions of intraoperative US during hip arthroscopy are limited in the literature. However, existing technique reports demonstrate the feasibility of US for both portal placement with superficial probes and limited evaluation of cartilage using intraarticular US catheters. Level of Evidence V, systematic review.

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“…Readers should keep in mind that the cumulative radiation exposure of hip preservation surgery is a combination of radiation from radiographs, CT scans, and intraoperative fluoroscopy. 10 The utility of imaging studies depends on image quality, user expertise, and the purpose of the study. Readers should keep in mind that the images from the low-dose CT protocol are suitable for surgical planning in the hands of expert surgeons in nonobese patients (body mass index < 35).…”

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confidence: 99%

Editorial Commentary: Low-Dose Hip Computed Tomography Sharpens the Saw for Hip Preservation: Can It Cut the Tree?

Kalore¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Computed tomography scans provide excellent visualization of complex hip deformities and assist in the diagnosis and surgical planning of hip preservation surgery. The dose of harmful ionizing radiation can be reduced while preserving reasonable image quality. Low-dose hip computed tomography can be used successfully for preoperative planning. Readers should consider strategies to reduce the radiation dose from computed tomography scans and consider magnetic resonance imaging arthrograms for assessment of cartilage and labral status before hip preservation surgery.

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Cumulative Radiation Exposure to Patients Undergoing Arthroscopic Hip Preservation Surgery and Occupational Radiation Exposure to the Surgical Team

Cited by 19 publications

References 35 publications

Intraoperative Radiation Exposure During Hip Arthroscopy

Intraoperative Radiation Exposure During Hip Arthroscopy

Is There a Role for Ultrasound in Hip Arthroscopy? A Systematic Review

Editorial Commentary: Low-Dose Hip Computed Tomography Sharpens the Saw for Hip Preservation: Can It Cut the Tree?

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