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The impact of the fluoroscopic view on radiation exposure in pelvic surgery: organ involvement, effective dose and the misleading concept of only measuring fluoroscopy time or the dose area product

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Abstract

Introduction

Minimally invasive fluoroscopy-guided screw fixation is an established technique to stabilize fractures of the posterior pelvic ring in orthopaedic surgery. However, safe placement of the screws may be associated with prolonged intervention time and extensive fluoroscopy is a concern. In the current literature, the dose area product (DAP) and fluoroscopy time are often used to describe radiation exposure of the patient. It was the aim of the study to compare DAP to organ doses and the effective dose for four standard views commonly used in pelvic surgery.

Methods

An anthropomorphic cross-sectional dosimetry phantom, representing the body of a male human (173 cm/73 kg), was equipped with metal–oxide–semiconductor field-effect transistors (MOSFET) in different organ locations to measure radiation exposure. Anteroposterior (APV), lateral (LV), outlet (OLV) and inlet (ILV) of the phantom were obtained with a mobile C-arm, and effective dose and organ doses were calculated. DAP was measured in the built-in ionisation chamber beyond the collimator of the C-arm. The measurements were repeated with a fat layer to simulate an obese patient.

Results

Overall, the highest organ dose was measured in the stomach for ILV (0.918 mSv/min). Effective dose for ILV showed the highest values by far (1.85 mSv/min) and the lowest for LV (0.46 mSv/min). The DAP pattern was completely different to the effective dose with similar values for LV and ILV (12.2 and 12.3 µGy·m2/s). Adding a fat layer had no major effect on the measurements.

Conclusion

The exposure to radiation varies considerably between different orthopaedic standard views of the pelvis. About the fourfold amount of the effective dose was measured for ILV compared to LV. DAP and irradiation time do not respect either the body region in the field of radiation or the radiosensitivity of the affected organs. Thus, they do not allow a reliable interpretation of the radiation burden the patient is exposed to.

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Acknowledgements

We thank Siemens Healthineers GmbH in Forchheim, Germany for supporting this study. A special thanks goes to Elizaveta Stepina, Hauke Prenzel, Robert Brauweiler and Peter Bartl for their technical support.

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Authors and Affiliations

  1. Division for Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Brauerestrasse 15, CH-8401, Winterthur, Switzerland

    Hannes Kuttner, Emanuel Benninger & Christoph Meier

  2. Division for Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Brauerstarsse 15, CH-8401, Winterthur, Switzerland

    Valentin Fretz

Authors
  1. Hannes Kuttner
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  2. Emanuel Benninger
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  3. Valentin Fretz
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  4. Christoph Meier
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Contributions

Conceptualization, H.K., E.B. and C.M.; Methodology, H.K., E.B., V.F. and C.M.; Investigations, H.K., E.B., C.M.; Writing – Original Draft, H.K. and C.M; Writing – Review & Editing, E.B. and V.F.; Visualization, H.K. and C.M; Supervision, E.B. and C.M.; Projekt Administration, C.M.

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Correspondence to Hannes Kuttner.

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The authors declare that they have no conflict of interest. Each author certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

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Kuttner, H., Benninger, E., Fretz, V. et al. The impact of the fluoroscopic view on radiation exposure in pelvic surgery: organ involvement, effective dose and the misleading concept of only measuring fluoroscopy time or the dose area product. Eur J Orthop Surg Traumatol 32, 1399–1405 (2022). https://doi.org/10.1007/s00590-021-03111-z

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  • DOI: https://doi.org/10.1007/s00590-021-03111-z

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