Background: Use of c-arm fluoroscopy is common in the operating room, outpatient clinic, and emergency department. Consequently, there is a concern regarding radiation exposure. Mini-c-arm fluoroscopes have gained popularity; however, few studies have quantified exposure during mini-c-arm imaging of a body part larger than a hand or wrist. The purpose of this study was to measure radiation exposure sustained by the patient and surgeon during the use of large and mini-c-arm fluoroscopy of an ankle specimen.
Methods: Standard and mini-c-arm fluoroscopes were used to image a cadaver ankle specimen, which was suspended on an adjustable platform. Dosimeters were mounted at specific positions and angulations to detect direct and scatter radiation. Testing was conducted under various scenarios that altered the proximity of the specimen and the radiation source. We attempted to capture a range of exposure data under conditions ranging from a best to a worst-case scenario, as one may encounter in a procedural setting.
Results: With all configurations tested, measurable exposure during use of the large-c-arm fluoroscope was considerably higher than that during use of the mini-c-arm fluoroscope. Patient and surgeon exposure was notably amplified when the specimen was positioned closer to the x-ray source. The exposure values that we measured during ankle fluoroscopy were consistently higher than the exposure values that have been recorded previously during hand or wrist imaging.
Conclusions: Exposure of the patient and surgeon to radiation depends on the tissue density and the shape of the imaged extremity. Elevated exposure levels can be expected when larger body parts are imaged or when the extremity is positioned closer to the x-ray source. When it is possible to satisfactorily image an extremity with use of the mini c-arm, it should be chosen over its larger counterpart.
Clinical Relevance: Orthopaedists should exercise caution, and consistently follow radiation safety guidelines, when using c-arm fluoroscopes because there is a real risk of radiation exposure.