Service de Chirurgie Orthopédique et Traumatologique, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, 165, Chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Université Clermont Auvergne, 49, Boulevard François Mitterrand, 63000 Clermont-Ferrand, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, 58, Rue Montalembert, 63000 Clermont-Ferrand, France.
Direction de la Recherche Clinique et de l'Innovation, CHU Clermont Ferrand, Clermont-Ferrand, France.
Orthop Traumatol Surg Res. 2021 Oct;107(6):102994. doi: 10.1016/j.otsr.2021.102994. Epub 2021 Jun 29.
Foot and ankle surgeons make daily use of mini-C-arm fluoroscopes. The present study aimed to quantify associated radiation doses.
X-ray exposure for foot and ankle surgeons using a mini-C-arm fluoroscope is below the nuclear safety authority authorized doses of 20 mSv/year for the whole body and crystalline lens, 150 mSv/year for the thyroid and 500 mSv/year for the skin and limbs.
A single-center, single-surgeon prospective series was treated between February 2014 and December 2017. Doses emitted by the mini-C-arm (15cm field) were recorded during 1,064 operations. Doses received by the surgeon were recorded by 3 passive dosimeters (thorax, eyes and hands) and 1 active dosimeter. The significance threshold was set at p<0.05.
A total of 64.4% of procedures concerned the forefoot, 35.3% the hindfoot and ankle, and 0.3% were strictly percutaneous. Mean dose-area product (DAP) per procedure was 3.9 cGy/cm±7: in forefoot surgery, 1.1 cGy/cm±0.9, and in hindfoot and ankle surgery 8.7 cGy/cm±9.7 (p<0.05), for mean irradiation times of 7.6s±5.3 and 36.7s±35.5 respectively and image numbers 4.1±2.7 and 18.7±20.5. Total ankle replacement was associated with the highest doses: 20.1 cGy/cm±14.7. Mean daily active dosimetry was 2.2μSv±1.4. Mean annual dose to the hand, crystalline lens and deep (Hp(10)) and shallow (Hp(0.07)) whole body was respectively 1.28 mSv, 0.6 mSv, 0.31 mSv and 0.19 mSv. The highest annual exposure was recorded for the hands: 2.68 mSv in 2015. There was a significant linear relationship between daily active dosimetry and daily emission: daily active dosimetry=(DAP×0.11)+0.54, for a correlation coefficient of 0.77.
DISCUSSION/CONCLUSION: The exposure of foot and ankle surgeons using mini-C-arms was well below threshold, and also lower than in the literature.
IV.
足踝外科医生日常使用微型 C 臂 X 光机。本研究旨在量化相关辐射剂量。
使用微型 C 臂 X 光机的足踝外科医生的 X 射线照射低于核安全局授权的全身和晶状体 20 mSv/年、甲状腺 150 mSv/年、皮肤和四肢 500 mSv/年的剂量。
2014 年 2 月至 2017 年 12 月期间，在一家中心，由一位外科医生进行了单中心、单外科医生前瞻性系列研究。记录了 1064 次手术中微型 C 臂（15cm 视野）发出的剂量。通过 3 个被动剂量计（胸部、眼睛和手部）和 1 个主动剂量计记录外科医生接受的剂量。显著性阈值设为 p<0.05。
64.4%的手术涉及前足，35.3%涉及后足和踝关节，0.3%为严格经皮手术。每次手术的平均剂量面积乘积（DAP）为 3.9 cGy/cm±7：前足手术为 1.1 cGy/cm±0.9，后足和踝关节手术为 8.7 cGy/cm±9.7（p<0.05），平均照射时间分别为 7.6s±5.3 和 36.7s±35.5，图像数量分别为 4.1±2.7 和 18.7±20.5。全踝关节置换术的剂量最高：20.1 cGy/cm±14.7。平均每日主动剂量计为 2.2μSv±1.4。手部、晶状体和深部（Hp(10)）和浅层（Hp(0.07)）全身的平均年剂量分别为 1.28 mSv、0.6 mSv、0.31 mSv 和 0.19 mSv。手部的年暴露量最高：2015 年为 2.68 mSv。每日主动剂量计与每日发射量之间存在显著的线性关系：每日主动剂量计=（DAP×0.11）+0.54，相关系数为 0.77。
讨论/结论：使用微型 C 臂的足踝外科医生的辐射暴露量低于阈值，也低于文献中的水平。
IV。
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