van Rappard Juliaan R M, Hummel Willy A, de Jong Tijmen, Mouës Chantal M
Department of General Surgery, Leeuwarden, The Netherlands.
Department of Plastic and Reconstructive Surgery, Leeuwarden, The Netherlands.
Hand (N Y). 2019 Nov;14(6):765-769. doi: 10.1177/1558944718770210. Epub 2018 Apr 17.
The use of intraoperative fluoroscopy has become mandatory in osseous hand surgery. Due to its overall practicality, the mini C-arm has gained popularity among hand surgeons over the standard C-arm. This study compares image quality and radiation exposure for patient and staff between the mini C-arm and the standard C-arm, both with flat panel technology. An observer-based subjective image quality study was performed using a contrast detail (CD) phantom. Five independent observers were asked to determine the smallest circles discernable to them. The results were plotted in a graph, forming a CD curve. From each curve, an image quality figure (IQF) was derived. A lower IQF equates to a better image quality. The patients' entrance skin dose was measured, and to obtain more information about the staff exposure dose, a perspex hand phantom was used. The scatter radiation was measured at various distances and angles relative to a central point on the detector. The IQF was significantly lower for the mini C-arm resulting in a better image quality. The patients' entrance dose was 10 times higher for the mini C-arm as compared with the standard C-arm, and the scatter radiation threefold. Due to its improved image quality and overall practicality, the mini C-arm is recommended for hand surgical procedures. To ensure that the surgeons' radiation exposure is not exceeding the safety limits, monitoring radiation exposure using mini C-arms with flat panel technology during surgery should be done in a future clinical study.
术中透视在手部骨外科手术中已成为必需手段。由于其整体实用性，小型C形臂相较于标准C形臂在手部外科医生中更受欢迎。本研究比较了采用平板技术的小型C形臂和标准C形臂在患者及工作人员的图像质量和辐射暴露情况。使用对比细节（CD）体模进行了基于观察者的主观图像质量研究。邀请了五名独立观察者确定他们能分辨出的最小圆圈。将结果绘制成图表，形成一条CD曲线。从每条曲线得出一个图像质量数值（IQF）。IQF越低，图像质量越好。测量了患者的皮肤入口剂量，为获取更多关于工作人员暴露剂量的信息，使用了有机玻璃手部体模。在相对于探测器上一个中心点的不同距离和角度测量了散射辐射。小型C形臂的IQF显著更低，图像质量更好。小型C形臂的患者皮肤入口剂量比标准C形臂高10倍，散射辐射高三倍。鉴于其图像质量的提升和整体实用性，推荐在手部外科手术中使用小型C形臂。为确保外科医生的辐射暴露不超过安全限值，未来的临床研究应在手术期间使用采用平板技术的小型C形臂监测辐射暴露情况。
