Skip to main content

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

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

References

  1. 1.

    Routt ML, Kregor PJ, Simonian PT, Mayo KA (1995) Early results of percutaneous iliosacral screws placed with the patient in the supine position. J Orthop Trauma. [Internet] 9(3):207–14

    Article  Google Scholar 

  2. 2.

    Gardner MJ, Routt MLC (2011) Transiliac-transsacral screws for posterior pelvic stabilization. J Orthop Trauma [Internet]. 25(6):378–84

    Article  Google Scholar 

  3. 3.

    Matta JM, Saucedo T (1989) Internal fixation of pelvic ring fractures. Clin Orthop Relat Res [Internet]. 1(242):83–97

    Google Scholar 

  4. 4.

    Chip Routt ML, Meier MC, Kregor PJ, Mayo KA (1993) Percutaneous iliosacral screws with the patient supine technique. Oper Tech Orthop [Internet]. 3(1):35–45

    Article  Google Scholar 

  5. 5.

    Miller AN, Routt MLC (2012) Variations in Sacral Morphology and Implications for Iliosacral Screw Fixation. Am Acad Orthop Surg [Internet]. 20(1):8–16

    Article  Google Scholar 

  6. 6.

    Hilgert RE, Finn J, Egbers HJ (2005) Technik der perkutanen SI-verschraubung mit unterstützung durch konventionellen C-bogen. Unfallchirurg 108:954–960

    CAS  Article  Google Scholar 

  7. 7.

    Zwingmann J, Konrad G, Kotter E, Südkamp NP, Oberst M (2009) Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure. Clin Orthop Relat Res [Internet]. 467(7):1833–8

    Article  Google Scholar 

  8. 8.

    Dosimetry in Diagnostic Radiology: An International Code of Practice [Internet]. Vienna: International Atomic Energy Agency; 2007. Available from: https://www.iaea.org/publications/7638/dosimetry-in-diagnostic-radiology-an-international-code-of-practice

  9. 9.

    The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP [Internet]. 2007;37:1–332. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18082557

  10. 10.

    Aalbers T, Duane S, Kapsch R-P, Meghzifene A. (2008) Measurement uncertainty - a practical guide for secondary standards dosimetry laboratories [Internet]. Available from: https://www-pub.iaea.org/MTCD/publications/PDF/te_1585_web.pdf

  11. 11

    Routt ML, Simonian PT, Mills WJ (1997) Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma [Internet]. 11(8):584–9

    Article  Google Scholar 

  12. 12

    Briem D, Windolf J, Rueger JM (2007) Percutaneous, 2D-fluoroscopic navigated iliosacral screw placement in the supine position: technique, possibilities, and limits. Unfallchirurg [Internet]. 110(5):393–401

    CAS  Article  Google Scholar 

  13. 13.

    Zwingmann J, Konrad G, Kotter E, Südkamp NP, Oberst M (2009) Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure. Clin Orthop Relat Res. 467(7):1833–8

    Article  Google Scholar 

  14. 14

    Richter PH, Steinbrener J, Schicho A, Gebhard F (2016) Does the choice of mobile C-arms lead to a reduction of the intraoperative radiation dose? Injury [Internet]. 47(8):1608–12

    CAS  Article  Google Scholar 

Download references

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.

Author information

Affiliations

Authors

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.

Corresponding author

Correspondence to Hannes Kuttner.

Ethics declarations

Conflict of interests

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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 (2021). https://doi.org/10.1007/s00590-021-03111-z

Download citation

Keywords

  • Fluoroscopy
  • Effective dose
  • Organ dose
  • Dose area product
  • Anteroposterior view
  • Lateral view
  • Outlet view
  • Inlet view
  • Posterior pelvic ring