C-arm fluoroscopy is frequently used in orthopedic surgery and repeatedly exposes operating room personnel to ionizing radiation, which poses documented long-term health risks. Radiation safety strategies include the use of personal protective equipment and variations in C-arm use. We hypothesized that using the lowest possible radiation (LPR) setting on the C-arm could reduce radiation emission at its source while maintaining sufficient image quality and without any compromise for the surgeon. The LPR components are quarter-dose mode (Low-dose LD instead of standard dose) and pulsed images (four images per second instead of 24 images/sec). This study aimed to determine whether LPR parameters could reduce the total radiation exposure during surgery compared to the standard method. A retrospective study of patient records between 2022/03/15 and 2024/08/01 was undertaken to retrieve imaging information and the type of surgery. The cumulative radiation dose (CD, in milliGray) and exposure duration (d, in seconds) were obtained from the radiation report automatically generated by the C-arm console. The relative radiation dose (RD = CD/d, in mGy per second) was calculated to compare results across different groups, which included four anatomical regions: distal lower limb (dLL) - tibia, ankle, and foot; proximal lower limb (pLL) - hip, femur, and patella; distal upper limb (dUL) - forearm and wrist; proximal upper limb (pUL) - shoulder and humerus. Four-hundred-thirty-two cases were reviewed, 193 in LPR and 239 in standard dose. The four groups included: 226 dLL, 100 pLL, 56 dUL and 50 pUL. Using LPR parameters resulted in significant RD reductions across all groups, with an overall average reduction of 55% (p < 0 .01) and individual group reductions of 44% (p < 0 .01), 68% (p < 0 .01), 41% (p < 0 .01), and 96% (p≤0.01) respectively. There was no significant difference in the total duration of radiation exposure, reflecting the number of images required, between modes in the different groups, except for dUL with a decrease of 49% in LPR mode (p < 0 .01). Using the C-arm with the LPR parameters (quarter-dose mode and pulsed images) in orthopedic surgery allows a significant mean reduction of 55% in radiation exposure for operating room personnel without affecting the number of images taken by the surgeon.
Arsenault et al. (Wed,) studied this question.