Nadig Nischal, Shaw Kenneth Aaron, Mottern Edward, Bojescul John, Mueller Terry
Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, USA.
Orthop J Sports Med. 2018 Oct 15;6(10):2325967118801275. doi: 10.1177/2325967118801275. eCollection 2018 Oct.
Fluoroscopic guidance is routinely utilized during hip arthroscopic surgery. Previous studies have shown that the C-arm orientation can significantly affect radiation exposure for both the surgeon and the patient during orthopaedic procedures. However, this has not been previously assessed for hip arthroscopic surgery.
Using an inverted C-arm during hip arthroscopic surgery will reduce radiation exposure to the patient and surgeon.
Descriptive laboratory study.
A simulation study measured scatter radiation during hip arthroscopic surgery performed in the supine position under fluoroscopic guidance with an anthropomorphic pelvic phantom on a radiolucent operating table. Radiation exposure tested 2 different C-arm orientations: standard and inverted. Testing was performed at 6 locations corresponding to the patient, surgeon's neck, surgeon's waist, surgical technician, anesthesiologist, and radiology technician. Statistical analysis was performed using univariate and multivariate analyses assessing radiation exposure between the C-arm orientations. A risk calculation for carcinogenesis was performed based on reported radiation dosages.
Radiation exposure (in mGy/min) was more than 100-fold higher for the patient compared with the surgeon in both C-arm orientations. The inverted C-arm orientation resulted in a 2.48-fold decrease in patient radiation exposure when compared with the standard orientation (10.8 mGy/min vs 26.8 mGy/min, respectively). There was a small but significant increase in surgeon radiation exposure in the inverted orientation compared with the standard orientation (0.072 vs 0.067 mGy/min, respectively). The patient's carcinogenesis risk was decreased 2.64-fold with the inverted orientation compared with the standard orientation (1.4 × 10 vs 3.7 × 10, respectively).
The inverted C-arm orientation resulted in a 2.48-fold decrease in patient radiation exposure with a 2.64-fold decrease in the carcinogenesis risk compared with the standard orientation. Inadvertently, the inverted orientation provided a 9-cm increase in the surgeon's working area. Our data supported the clinical utilization of the inverted C-arm orientation during hip arthroscopic surgery to minimize patient radiation exposure. Although there was a minimal but significant increase in surgeon radiation exposure with the inverted orientation, we believe that this is negligible when incorporated with standard leaded protective equipment as contrasted with the significant dose reduction for the patient as well as the decreased risk of carcinogenesis and hereditary disorders.
Patients undergoing hip arthroscopic surgery routinely acquire radiation exposure during the use of the C-arm. Measures to minimize radiation via the inverted C-arm orientation will decrease the unnecessary risk to the patient while continuing to allow for optimal treatment.
在髋关节镜手术中通常会使用荧光透视引导。先前的研究表明，在骨科手术过程中，C型臂的方向会显著影响术者和患者所接受的辐射剂量。然而，此前尚未针对髋关节镜手术进行过此类评估。
在髋关节镜手术中使用倒置的C型臂可减少患者和术者所接受的辐射剂量。
描述性实验室研究。
一项模拟研究在可透射线的手术台上，使用拟人化骨盆模型，对仰卧位荧光透视引导下的髋关节镜手术过程中的散射辐射进行测量。辐射剂量测试了两种不同的C型臂方向：标准方向和倒置方向。在与患者、术者颈部、术者腰部、手术技师、麻醉医生及放射技师相对应的6个位置进行测试。采用单因素和多因素分析评估不同C型臂方向之间的辐射剂量，并根据报告的辐射剂量进行致癌风险计算。
在两种C型臂方向下，患者所接受的辐射剂量（mGy/分钟）均比术者高出100倍以上。与标准方向相比，倒置C型臂方向使患者所接受的辐射剂量降低了2.48倍（分别为10.8 mGy/分钟和26.8 mGy/分钟）。与标准方向相比，倒置方向使术者所接受的辐射剂量有小幅但显著的增加（分别为0.072 mGy/分钟和0.067 mGy/分钟）。与标准方向相比，倒置方向使患者的致癌风险降低了2.64倍（分别为1.4×10和3.7×10）。
与标准方向相比，倒置C型臂方向使患者所接受的辐射剂量降低了2.48倍，致癌风险降低了2.64倍。不经意间，倒置方向使术者的工作区域增加了9厘米。我们的数据支持在髋关节镜手术中使用倒置C型臂方向以尽量减少患者的辐射剂量。尽管倒置方向使术者所接受的辐射剂量有小幅但显著的增加，但我们认为，与患者辐射剂量的显著降低以及致癌风险和遗传性疾病风险的降低相比，在使用标准铅防护设备的情况下，这一增加可忽略不计。
接受髋关节镜手术的患者在使用C型臂时通常会受到辐射。通过倒置C型臂方向来尽量减少辐射的措施，将在继续允许进行最佳治疗的同时降低患者不必要的风险。
