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The Effect of Orthopedic Hardware on Patient and Surgical Team Scatter Radiation Exposure Utilizing Mini C-arm in a Simulated Wrist Fracture Fixation Model
Michael T Groover, DO1; H. B. Bamberger; DO, FAOAO1; Jacob R Hinkley, BS2; Jenn Evans, DO1; Roland Gazaille, DO1
1Ohio University Grandview Medical Center, Dayton, OH; 2Des Moines University College of Osteopathic Medicine, Des Moines, IA

Introduction: The use of fluoroscopic imaging in orthopedic surgery has become more commonplace over the last few decades. Occupational risk of routine, increased use of fluoroscopy is due to the unknown effects of chronic low-level radiation exposure. The mini-C-arm is commonly used in upper extremity surgery and is generally perceived as safe. Studies have investigated radiation scatter in the past, but to our knowledge no studies have compared the effect of absence or presence of orthopedic hardware (plates/screws/retractors) in the fluoroscopy field with respect to changes in the intensity, direction of scatter, and degree of radiation exposure to the patient and surgical team. Furthermore, there is limited literature describing alteration in scatter exposure with changing the orientation of the mini-C-arm. The goal of this study was to determine if the presence of orthopedic hardware increases scatter radiation exposure to the patient and surgical team when using mini-C-arm in the horizontal and vertical positions.

Materials and Methods: 4 trials were conducted using a lamb limb specimen and a standard mini-C-arm to simulate a forearm/wrist fracture fixation scenario. Trials 1 and 2 tested scatter with no metal on the field and with the mini-c-arm in the vertical and horizontal position. Trials 3 and 4 tested scatter radiation with a 6 hole 3.5 mm LCDCP plate attached to the specimen in the standard fashion with 6 cortical screws and a self-retaining retractor with mini-C-arm in vertical and horizontal positions. We used a parallel plate radiation detector to measure scatter directed at the region of the eyes, thyroid, chest, hands (surgeon only) and gonads of the patient and surgical staff. Comparisons were made using scatter percentage (scatter/direct beam x 100).

Results: The patient, scrub technician, circulating nurse, and anesthesiologist were exposed to no detectable scatter radiation. However, the presence of orthopedic hardware in the fluoroscopy field produced a substantial 181-fold increase in scatter radiation exposure to first assistant's eyes (0.016% v 2.893%) in the horizontal mini-c-arm position trials. Exposure to the surgeon's hands was increased in the horizontal position with the presence of orthopedic hardware.

Conclusion: Orthopedic hardware in the fluoroscopy field increases radiation scatter exposure to a degree that may place the first assistant's yearly eye exposure in excess of the current International Commission on Radiological Protection (ICRP) limit. We advise to always wear lead aprons, thyroid shields, and leaded glasses when working in close proximity to the operative field.

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