Ionising radiation exposure in paediatric trauma

Patel, NG; Mohamed, A; Cooper, Gregory S.; McFadyen, I.

doi:10.1308/003588414x13814021677313

Cited by 13 publications

(17 citation statements)

References 8 publications

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“…We found that surgeon experience correlated with radiation exposure. This is in line with the study by Patel et al [ 3 ]. In paediatric orthopaedic trauma cases, they found that consultant surgeons used 51% less screening time and 35% less radiation exposure (as measured by DAP), than junior surgeons.…”

Section: Discussionsupporting

confidence: 94%

“…To our knowledge, there are only two studies that have attempted to report this. Patel et al [ 3 ] reported screening time and DAP of 782 paediatric trauma cases utilizing fluoroscopy in the operating room. Salvia et al studied the radiation exposure in 80 orthopaedic cases (16 different surgery types).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have commented on radiation exposure for orthopaedic trauma procedures requiring fluoroscopy [ 2 – 4 ]. These are often limited by low numbers [ 4 ], incomplete data [ 2 ], or only focus on a subset of patients [ 3 ] and therefore are not applicable to most orthopaedic trauma cases treated in an average hospital. Radiation exposure remains a significant occupational hazard to the orthopaedic surgeon throughout their career [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Intra-operative fluoroscopic radiation exposure in orthopaedic trauma theatre

Rashid

Aziz

Haydar

et al. 2017

Eur J Orthop Surg Traumatol

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IntroductionRadiation exposure from intra-operative fluoroscopy in orthopaedic trauma surgery is a common occupational hazard. References for fluoroscopy use in the operating room for commonly performed operations have not been reported adequately. This study aimed to report appropriate intra-operative fluoroscopy use in orthopaedic trauma and compare the effect of surgery type and surgeon grade on radiation exposure.MethodsData on 849 cases over an 18-month period were analysed retrospectively. Median and 75th centile values for dose area product (DAP), screening time (ST), and number of fluoroscopy images were calculated for procedures where n > 9 (n = 808).ResultsMedian DAP for dynamic hip screws for extracapsular femoral neck fractures was 668 mGy/cm2 (ST 36 s), 1040 mGy/cm2 (ST 49 s) for short proximal femoral nail, 1720 mGy/cm2 (ST 2 m 36 s) for long femoral nail for diaphyseal fractures, 25 mGy/cm2 (ST 25 s) for manipulation and Kirschner wire fixation in distal radius fractures, and 27 mGy/cm2 (ST 23 s) for volar locking plate fixation in distal radius fractures. These represented the five commonest procedures performed in the trauma operating room in our hospital. Experienced surgeons utilized less radiation in the operating room than junior surgeons (DAP 90.55 vs. 366.5 mGy/cm2, p = 0.001) and took fewer fluoroscopic images (49 vs. 66, p = 0.008) overall.ConclusionsThis study reports reference values for common trauma operations. These can be utilized by surgeons in the operating room to raise awareness and perform clinical audits of appropriate fluoroscopy use for orthopaedic trauma, using this study as guidance for standards. We demonstrated a significant reduction in fluoroscopy usage with increasing surgeon experience.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intra-operative fluoroscopic radiation exposure in orthopaedic trauma theatre

Rashid

Aziz

Haydar

et al. 2017

Eur J Orthop Surg Traumatol

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“…A recent quantification study of radiation exposures in 248 children reported that the mean DAP exposure of supracondylar fractures and flexible nailing of the forearm were 22.3 and 26.7 mGy/cm 2 , respectively [ 20 ]. One study documented that the mean DAP of elbow fracture treatments performed by experienced surgeons was 87.41 mGy/cm 2 [ 21 ]. Poor visualization of the radial head and neck, especially in young children, can increase radiation use.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography-guided reduction of pediatric radial neck fractures

Lee

Kim

Choi

2017

BMC Musculoskelet Disord

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BackgroundTreatment of displaced and angulated radial neck fractures in children is controversial and challenging. Numerous studies have been conducted regarding treatment algorithms and surgical techniques that use fluoroscopy. However, ultrasonography (US)-guided reduction of pediatric radial neck fractures has not been reported yet. We aimed to determine the safety and efficacy of US-guided reduction and fixation of radial neck fractures in children.MethodsAmong 28 cases of radial neck fracture from 2014 to 2016, 12 were classified as type III or IV according to the Judet classification. All 12 patients underwent US-guided reduction and percutaneous fixation with Kirschner wire and follow-up for more than 6 months. US was used primarily to monitor the angulation and reduction of the radial neck. Fluoroscopy was applied to confirm the fixation with Kirschner wire. Dose area product (DAP; mGy/cm2) was measured to assess per-procedure radiation dose. Radiological and clinical results were evaluated at 6 months after the surgery by using the Metaizeau criteria.ResultsOf the patients, 4 were boys and 8 were girls, with a mean age of 7.7 years (range, 5–11 years). Judet type III fractures accounted for 83% of all injuries. The mean preoperative radial angulation was 62.5° (range: 46°–76°). The mean postoperative radial angulation was 5.6° (range: 2°–9°). The mean fluoroscopy time was 31 s (range: 10–73 s), and the mean DAP was 10.7 mGy/cm2 (range: 7.2–18.7 mGy/cm2). The mean follow-up period was 18.3 months (range, 8–24 months). According to the Metaizeau criteria, 10 cases were excellent and 2 cases were good at the last follow-up.ConclusionsUS-guided reduction and percutaneous fixation is safe and reliable option to treat displaced radial neck fractures in children.

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“…11 Unfortunately, the long-term effects of radiation exposure of this sort are largely unknown, and concern exists that even small doses may be detrimental because they accumulate over the lifespan, with children particularly being nearly 10 times more sensitive than adults. 12 Radiographs also contribute to healthcare expenditure, waiting times, and strains on personnel and resources. 13 Thus, if evidence is strong that routine radiography has minimal utility in patient management, restricting it to patients with clinical indications would not only help decrease radiation exposure but also free resources for other hospital needs.…”

mentioning

confidence: 99%