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American Association for Hand Surgery

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Radiation Exposure of Large versus Mini C-arm in Hand/Wrist Fractures: Cadaveric Study and a Review of the Current Literature
Ammer M Dbeis, DO, MS, Sahil Vohra, DO, Logan Cone, MS-IV, Sharon Woo, MS-IV and Joshua Gluck, MD, Community Memorial Health System, Ventura, CA

Introduction: Hand and wrist procedures have become increasingly reliant on intraoperative fluoroscopy. Though it contributes to improved post-operative surgical outcomes, the use of fluoroscopy does not come without consequences. Previous studies have investigated how differences in equipment, C-arm orientation, and procedure set-up affect both direct and scatter radiation exposure; however, there are conflicting conclusions. The purpose of this study is to clarify the differences in direct and scatter radiation exposure between the large C-arm and mini C-arm in hand/wrist procedures on cadaveric models and perform a review of the current literature.
Materials & Methods: We used one large and one mini C-arm for our study. Both C-arms were tested in the vertical position with the image intensifier below the cadaver arm. We used 1 fresh frozen cadaver upper extremity in the study. The specimen was tested with each C-arm in two configurations: placing the specimen directly on the image intensifier and placing the cadaver specimen on a hand table then imaging through the table with the image intensifier below. For both configurations we used a standard Globus Medical stainless steel, single row multi-hole distal radius volar locking plate. For each irradiation process we placed a Radcal 2025 micrometer directly on the cadaver skin at the center of the beam as a marker for patient exposure. We also placed a Victoreen 450P ion chamber at the surgeon's waist height to measure the scatter radiation and exposure to the surgeon and assistant.
Results: In both configurations, the mini C-arm transmitted increased levels of radiation to the cadaver and scatter to the surgeon. Specifically, exposure directly on the arm with no hand table resulted in 161% more direct exposure to the cadaver arm and 73% more scatter exposure to the surgeon's waist with the mini C-arm. With the addition of the hand table, the mini C-arm resulted in a 320% increase in exposure to the cadaver arm and 100% more radiation scatter to the surgeon's waist. With installation of a surgical repair plate in both configurations, the mini C-arm resulted in 170% more cadaver exposure and 67% more surgeon scatter exposure without the arm table, and 390% more to the cadaver and 3% more to the surgeon with arm table.
Conclusions: Large C-arm produces less initial radiation and less scatter exposure compared to mini c-arm using cadaveric specimens, with and without both the hand table and surgical plate.


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