Hooper Hand Unit, St John's Hospital, NHS Lothian, Livingston, United Kingdom.
Hooper Hand Unit, St John's Hospital, NHS Lothian, Livingston, United Kingdom.
Surgeon. 2021 Dec;19(6):e338-e343. doi: 10.1016/j.surge.2020.08.007. Epub 2020 Sep 28.
Under the Ionising Radiation Medical Exposure Regulations, hospitals using fluoroscopy and image intensifiers should monitor doses from exposures using ionising radiation. There is a need for national diagnostic reference levels to advise Orthopaedic and Plastic surgeons on safe screening times and radiation doses for patients having upper limb surgical procedures.
Retrospective study of all patients who underwent upper limb surgical procedures requiring intra-operative mini C-arm image intensifier use at our hospital between 2013 and 2019. This included results from three machines in different rooms. Procedures were classified as closed and open procedures.
Information on a total of 2910 procedures over 6 years (June 2013 to June 2019) were obtained. 133 procedures with incomplete data and 4 cases of lower extremities were excluded. 1719 closed procedures had a median dose area product of 0.48 cGycm and median screening time of 7 s, compared to 1054 open procedures, with a median dose area product of 1.88 cGycm and median screening time of 28 s. National diagnostic reference levels are set at the third quartile and indicate the difference between good and poor practice. For diagnostic reference levels, we suggest a dose area product of 0.82 cGycm and a screening time of 11 s for closed procedures and a dose area product of 3.07 cGycm and screening time of 40 s for open procedures. Public Health England state that national diagnostic reference levels should be derived from multiple patients, radiology rooms and hospitals. Our data meets the first two criteria and is an initial step in establishing national diagnostic reference levels for upper limb mini C-arm use.
This large audit reports results, which, with further work across multiple hospital sites, should lead to establishing national diagnostic reference levels for mini C-arm fluoroscopy for upper limb Orthopaedic procedures.
根据《电离辐射医疗照射条例》，使用透视和影像增强器的医院应监测使用电离辐射进行的照射剂量。需要有国家诊断参考水平来告知矫形外科和整形外科医生，以便为接受上肢手术的患者确定安全的筛查时间和辐射剂量。
对我院 2013 年至 2019 年间所有接受上肢手术且术中需要使用微型 C 臂影像增强器的患者进行回顾性研究。这包括三间不同房间的三台机器的结果。手术分为闭合性和开放性手术。
在 6 年期间（2013 年 6 月至 2019 年 6 月）共获得 2910 例手术的信息。排除了 133 例数据不完整的手术和 4 例下肢手术。1719 例闭合性手术的剂量面积乘积中位数为 0.48 cGycm，筛查时间中位数为 7 秒，而 1054 例开放性手术的剂量面积乘积中位数为 1.88 cGycm，筛查时间中位数为 28 秒。国家诊断参考水平设定在第三四分位数，表明了良好和不良实践之间的差异。对于诊断参考水平，我们建议闭合性手术的剂量面积乘积为 0.82 cGycm，筛查时间为 11 秒，开放性手术的剂量面积乘积为 3.07 cGycm，筛查时间为 40 秒。英格兰公共卫生署指出，国家诊断参考水平应来自多个患者、放射科房间和医院。我们的数据符合前两个标准，是为上肢微型 C 臂使用建立国家诊断参考水平的初步步骤。
这项大型审计报告了结果，如果在多个医院地点开展进一步工作，应该可以为上肢矫形手术的微型 C 臂透视建立国家诊断参考水平。
