50% reduction of intraoperative radiation in orthopedics: impact of using the fluoroscopy's lowest possible radiation settings.

PURPOSE: This study aimed to determine whether the C-arm’s lowest possible radiation (LPR) setting could lower the total radiation exposure compared to the standard method, while maintaining sufficient image quality. The LPR options are quarter-dose mode (low-dose versus standard dose) and pulsed images (four images per second versus 24 images/sec).

METHODS

A retrospective study of patient records between 05/2023 and 08/2024 was undertaken to retrieve information on imaging and type of surgery. The cumulative radiation dose (CD, in milliGray) and exposure duration (d, in seconds) were retrieved from the report automatically generated by the fluoroscopy machine. The relative radiation dose (RD = CD/d, in mGy/sec) was calculated to compare results across different groups, which included four anatomical regions: distal lower limb (dLL) - tibia, ankle, and foot; proximal lower limb (pLL) - hip, femur, and patella; distal upper limb (dUL) - forearm and wrist; proximal upper limb (pUL) - shoulder and humerus.

RESULTS

Four-hundred-thirty-two cases were reviewed, 193 in LPR and 239 in standard dose. The four groups included: 226 dLL, 100 pLL, 56 dUL and 50 pUL. Overall RD decreased by 48%. Reductions by anatomical region were 76% (pUL), 64% (dUL), 75% (pLL), and 58% (dLL). There was no overall increase in total exposure duration with LPR mode (no increase in images taken).

CONCLUSION

Using the C-arm’s LPR settings for orthopedic surgery in a retrospective, two-surgeon design allows a significantly lower RD exposure of 48% for operating room personnel, with sufficient image quality not to impact the number of images required. LEVEL OF EVIDENCE: Level III.