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Measurement of Radiation Exposure When Using the Mini C-Arm to Reduce Pediatric Upper Extremity Fractures

Sumko, Michael J. DO; Hennrikus, William MD; Slough, Jennifer MD; Jensen, Kelly DO; Armstrong, Douglas MD; King, Stephen PhD; Urish, Kenneth MD

Journal of Pediatric Orthopaedics: March 2016 - Volume 36 - Issue 2 - p 122–125
doi: 10.1097/BPO.0000000000000422

Background: Previous literature has underreported radiation exposure with the use of mini C-arm during pediatric forearm fracture reductions. The purpose of this study is to report an accurate amount of radiation exposure during fracture reductions using a mini C-arm that records the amount of kilovolts, milliamps, and the number of seconds of foot pedal use.

Methods: Eighty-six consecutive pediatric patients undergoing upper extremity fracture reduction in the emergency department were studied. The orthopaedic resident, either a PGY2 or PGY3, performed a manipulative reduction and casting of the fracture with use of the mini C-arm. Postreduction, in cast, anteroposterior and lateral images from the mini C-arm were saved to the computerized radiology system. The mini C-arm recorded the amount of kilovolts, milliamps, and the number of seconds that the foot pedal was used for each reduction. A radiology physicist (S.K.) calculated the amount of millirem (mR) exposure for each reduction from these data.

Results: The resident using the mini C-arm and the fracture pattern affected the amount of radiation exposure. The average mini C-arm mR exposure for distal radius fractures was 63 mR; forearm 109 mR; elbow 53 mR; and hand 69 mR. For comparison, conventional anteroposterior/lateral forearm radiographs emit an average of 20 mR. Less-experienced PGY2 residents had a higher mR exposure per reduction compared with PGY3 residents.

Conclusions: Radiation exposure when using the mini C-arm for reduction of pediatric fractures has been underestimated in previous literature. Radiation from the mini C-arm exceeded that from conventional radiographs in most cases. We recommend that residents receive training about the use of the mini C-arm before its utilization as an aid to reduce pediatric fractures in the emergency department.

Level of Evidence/Clinical Relevance: Prospective study to evaluate the total amount of radiation exposure per pediatric forearm fracture reduction.

Penn State College of Medicine, Hershey, PA

The authors declare no conflicts of interest.

Reprints: Michael J. Sumko, DO, Penn State College of Medicine, 30 Hope Drive, Hershey, PA 17033. E-mail:

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