From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania.
Perelman School of Medicine.
Ann Plast Surg. 2022 May 1;88(3 Suppl 3):S309-S313. doi: 10.1097/SAP.0000000000003204.
Although occupational exposure to radiation has been previously studied in the hand surgery literature, there is a paucity of studies looking at radiation exposure to the patient during fluoroscopy-guided hand surgery. We aimed to describe the level of radiation experienced by patients undergoing common hand and wrist fracture fixation and to identify risk factors for increased radiation exposure.
We performed a retrospective review of patients at a single institution who underwent fracture fixation of the hand, wrist, or forearm requiring mini c-arm fluoroscopic guidance from 2016 to 2020. Data points collected included patient demographics, procedural details, and indicators of radiation exposure including dose-area product (DAP), total intraoperative images, and total fluoroscopy time. Effective dose (ED) was calculated using DAP, field size, and a previously established conversion factor.
The final sample included 361 patients with an average age of 46 years. Procedures included fixation of forearm fractures (3.3%), distal radius fractures (35.7%), metacarpal fractures (30.8%), and phalangeal fractures (30.2%). The median number of intraoperative images acquired was 36, median total fluoroscopy time was 43 seconds, median DAP was 4.8 cGycm2, and median ED was 0.13 μSv. Distal (metacarpal and phalangeal) fractures required more intraoperative images and longer total fluoroscopy time (49 images, 61 seconds) compared with proximal (forearm and distal radius) fractures (39 images, 47 seconds) (images, P = 0.004; exposure time, P = 0.004). However, distal fractures had a lower average ED compared with proximal fractures (0.15 vs 0.19 μSv, P = 0.020). When compared with open procedures, percutaneous procedures had higher DAPs (8.8 vs 4.9 cGycm2, P < 0.001), higher ED (0.22 vs 0.15 μSv, P < 0.001), more intraoperative images (65 vs 36 images, P < 0.001), and longer total fluoroscopy time (81.9 vs 44.4 seconds, P < 0.001).
Patient-level radiation exposure during fluoroscopy-guided hand and wrist procedures is low relative to other common imaging modalities, such as dental radiographs, chest x-rays, and computed tomography scans, and is comparable with less than a few hours of natural background radiation exposure, highlighting the overall safety of this important technology. Further study should be performed to establish reference ranges, which could lead to improved patient counseling and evidence-based guidelines on patient shielding.
尽管手部外科文献中已经研究了职业性辐射暴露，但很少有研究关注透视引导手部外科手术中患者的辐射暴露。我们旨在描述接受常见手部和腕部骨折固定术的患者所经历的辐射水平，并确定辐射暴露增加的危险因素。
我们对一家机构的患者进行了回顾性研究，这些患者在 2016 年至 2020 年间需要小型 C 臂透视引导进行手部、腕部或前臂骨折固定。收集的数据点包括患者人口统计学资料、手术细节以及辐射暴露指标，包括剂量面积乘积（DAP）、术中总图像数和总透视时间。有效剂量（ED）是通过 DAP、射野大小和先前建立的转换因子计算得出的。
最终样本包括 361 名平均年龄为 46 岁的患者。手术包括前臂骨折（3.3%）、桡骨远端骨折（35.7%）、掌骨骨折（30.8%）和指骨骨折（30.2%）。术中获取的图像中位数为 36 张，总透视时间中位数为 43 秒，DAP 中位数为 4.8 cGycm2，ED 中位数为 0.13 μSv。与近端（前臂和桡骨远端）骨折（39 张，47 秒）相比，远端（掌骨和指骨）骨折需要更多的术中图像和更长的总透视时间（49 张，61 秒）（图像，P=0.004；透视时间，P=0.004）。然而，与近端骨折相比，远端骨折的平均 ED 较低（0.15 比 0.19 μSv，P=0.020）。与开放手术相比，经皮手术的 DAP 更高（8.8 比 4.9 cGycm2，P<0.001），ED 更高（0.22 比 0.15 μSv，P<0.001），术中图像更多（65 比 36 张，P<0.001），总透视时间更长（81.9 比 44.4 秒，P<0.001）。
透视引导手部和腕部手术过程中患者的辐射暴露水平相对较低，低于其他常见影像学检查，如牙科射线照相、胸部 X 射线和计算机断层扫描，与数小时的自然背景辐射暴露相当，突出了这项重要技术的整体安全性。应进一步开展研究以建立参考范围，这可能有助于改善患者咨询和制定基于证据的患者屏蔽指南。
