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

Safe usage of Mini 'C'-arm in operating room environment: Implications for clinical practice

BACKGROUND

Mini 'C'-arm machine is an advanced medical imaging device used primarily for intraoperative imaging during surgical, orthopaedic and emergency care procedures. Since the technology is based on ionising radiation, safe usage of Mini 'C'-arm machine is mandatory to protect patients and operating personnel.

OBJECTIVE

The main objective is to describe the various components related to patients, operator and equipment to ensure safe usage of Mini 'C'-arm machine. A comprehensive search strategy using the PEO (Population, Exposure, Outcome) framework was conducted using Embase, PubMed, Google Scholar and ResearchGate databases to identify suitable literature. The keywords used for the search included 'Fluoroscopy', 'Ionising Radiation' and 'surgical safety'.

KEY FINDINGS

Safe usage of Mini 'C'-arm equipment involves components of operator training, operator safety, patient safety, radiation dose, operating room logistics, handling of images and auditing of Mini 'C'-arm use.

CONCLUSION

Mini 'C'-arm provides an invaluable, portable imaging tool in a spectrum of general surgical and orthopaedic interventional procedures. However, safe usage of Mini 'C'-arm machine requires a multifaceted approach including operator responsibility and safety, patient protection, equipment maintenance, radiation dose awareness, documentation and sound reporting mechanisms.

Development and experimental verification of C-arm camera shooting locator

This study aimed to develop a self-made C-arm camera shooting locator and verify its accuracy and advantages. 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. 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. 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.

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

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.