Intraoperative C-arm radiation affecting factors and reduction by an intervention program

Background: The increase in the utilization of fluoroscopy during surgical procedures carries with it an inherent increase in the exposure of both patients and surgical staff to ionizing radiation. The purpose of this study was to examine the ability to reduce radiation doses by the implementation of an intervention program targeted at the staff operating the fluoroscopy machinery and attempting to make a behavioral change in its utilization. Methods: (1) Fluoroscopy technique was optimized after a series of simulation fluoroscopies. (2) A series of lectures was given to all staff operating fluoroscopy equipment (surgeons and x-ray technicians). (3) Directives for the reduction of radiation were included in the preoperative briefing, a sign was displayed next to the fluoroscopy screen, and radiation data was discussed in postoperative conferences. The index procedure chosen for the study was closed reduction and percutaneous fixation of Gartland III supracondylar humerus fractures. Fluoroscopy time and dosage were compared in 43 cases before the intervention program (group A) and in 40 cases after the program (group B). Reduction accuracy was assessed by the Bauman angle, humerocapitellar angle, and rotation index. Results: The mean fluoroscopy time was 122 seconds (6-565) in group A and 54 seconds (1-188) in group B with a P value of 0.001. Radiation emission was 202 (5-1210) millirems in group A and 90 millirems (10-237) in group B (P = 0.005). The mean fluoroscopy time for a surgery performed by a resident was 126 seconds (27-431) with 211 (38-766) millirems of radiation. The presence of a senior surgeon reduced these figures to 75 seconds (1-565) (P = 0.003) and 127 millirems (5-1210) (P = 0.001). The effect of the intervention program was similar regardless of the level of training of the surgical staff. Reduction accuracy and complication rate were no different in the 2 groups. Conclusions: Radiation exposure is significantly affected by surgical and fluoroscopic techniques and by the surgeons' level of training. Exposure can be decreased significantly by awareness and behavioral modification.