Prospective observational analysis of intraoperative radiation exposure with a mini C-arm intensifier in percutaneous forefoot surgery

Abstract

IntroductionPercutaneous forefoot surgery has been associated with higher radiation exposure than the conventional approach. However, there is little data on forefoot surgery using a mini C-arm intensifier. We, therefore, conducted a prospective study to (1) evaluate the intraoperative radiation received by the surgeon during percutaneous forefoot surgery with a mini C-arm; (2) compare the radiation received by the surgeon with the guidelines for occupational exposure issued by the International Commission on Radiological Protection (ICRP) (20 millisieverts per year [mSv/year] for the whole body, 500mSv/year for the hands, and 20mSv/year for the lens of the eye); and (3) compare the radiation received during percutaneous forefoot surgery with that of the open approach, which has already been reported in the literature. HypothesisThe radiation received by the surgeon during percutaneous forefoot surgery with a mini C-arm is lower than the ICRP guidelines, and the findings reported in the literature. Materials and methodsThis prospective single-center study was conducted from September 2020 to May 2021. A total of 639 feet (i.e., 435 patients) were included. Of these 639 feet, 336 (52%) were hallux valgus repairs, 49 (8%) were stand-alone procedures of the lateral rays, and 124 (19%) were a combination of both. The radiation dose data was retrieved from the mini C-arm daily: dose-area product (DAP) in centigray per square centimeter (cGy/cm2) and radiation exposure duration in seconds. The doses received by the surgeon were collected every month by 4 passive dosimeters (hand, eye lens, and chest [on and under the lead apron]) and 2 active dosimeters (on and under the lead apron). ResultsThe DAP emitted by the mini C-arm during an operating day was 0.10±0.01cGy/cm2 (range, 0.0–3.9), and the mean daily radiation duration was 34.7±19.3seconds (range, 0.7–226.8). There was a mean of 8±8 (range, 1–18) elective procedures per operating day. The daily reading on the active dosimeter worn on the lead apron was 0.002±0 microSv (range, 0–0.04), while the one worn under the apron was 0.001±0 microSv (range, 0–0.03). The equivalent doses over the 7-month study period for the hand, eye lens, and chest (over and under the apron) were 0.14mSv, 0mSv, 0.22mSv, and 0mSv, respectively. Discussion/ConclusionThe radiation exposure in percutaneous forefoot surgery with a mini C-arm intensifier observed in our study was lower than the ICRP recommendations and literature findings during open surgery. Level of evidenceIV; prospective study without a control group.