PubMed · 577236
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J D Collins, S E Byrd, L W Bassett. 1977-06-20. Thoracentesis under fluoroscopic control.. https://pubmed.ncbi.nlm.nih.gov/577236/
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STUDY DESIGN: Case crossover design was conducted. OBJECTIVES: The purpose of the current study was to determine the radiation exposure level of operators performing fluoroscopically assisted vertebroplasty and to determine optimal techniques to reduce this exposure. SUMMARY OF BACKGROUND DATA: The use of ionizing radiation to provide quality imaging during minimally invasive orthopedic procedures has dramatically increased. One such procedure, vertebroplasty, which is the percutaneous fixation of fractured vertebrae with polymethylmethacrylate, requires the use of ionizing radiation of biplanar fluoroscopy. The adverse effects of excessive radiation exposure to occupational personnel may not be realized for several years. METHODS: Twelve months of occupational dose data for a single operator were evaluated and correlated to the modifications of practice habits implemented and shielding techniques used to reduce the operator's exposure while maintaining adequate image quality. RESULTS: Before the implementation of radiation-reduction procedures, the average whole-body dose per vertebroplasty procedure was 1.44 mSv/vertebrae, and the measured hand dose was 2.04 mSv/vertebrae. After implementation of radiation-reducing procedures and shielding techniques, the average whole-body dose per vertebroplasty procedure was 0.004 mSv/vertebrae, and the average hand dose was 0.074 mSv/vertebrae. Testing of the shielding device indicated a significant reduction in whole-body and hand doses. For the fluoroscopic modes investigated, the shielding used resulted in reductions ranging from 42.9% to 86.1%. CONCLUSION: It is critical that operators performing vertebroplasty procedures have a fundamental understanding of radiation physics and radiation protection to minimize radiation exposure.
Recent protocols for standardized knee radiography, which attempts to image the knee with reproducible, parallel alignment of the medial tibial plateau and radiograph beam, possess many theoretic advantages. As a group, they permit measurement of tibiofemoral joint space width with remarkable precision--the sine qua non of sensitive detection of change. However, only limited longitudinal data are available in peer-reviewed publications to permit a direct evaluation of the suitability of these protocols for use in multicenter clinical trials and studies of biomarkers of osteoarthritis (OA) progression. Longitudinal data from several National Institutes of Health-supported studies of OA progression, as reflected in radiographs acquired with high levels of standardization for radioanatomic positioning of the knee, should be available in the next several years. Alternatively, data from the placebo groups of several industry-supported phase III trials of purported disease-modifying OA drugs, which were terminated prematurely because of adverse events or lack of efficacy, may be made available for rapid analysis regarding the performance of current standardization protocols with respect to their sensitivity to disease progression.
Image-guided techniques have been well established in all surgical disciplines for years. To achieve an optimised work flow during image-guided surgery, the surgeon should be able to manipulate the visual feedback and therefore the imaging unit. C-arm fluoroscopy is the imaging modality routinely used for intraoperative imaging in orthopaedic surgery. The C-arm fluoroscope is positioned and handled by a radiographer on vocal commands, which means that the surgeon depends on external help to manipulate the visual feedback and the work flow is not optimised. The MEPUC interface adapts the C-arm fluoroscope to the needs of image-guided orthopaedic procedures. MEPUC is an acronym for Motorised Exact-Positioning Unit for C-arm. In the hardware component of the MEPUC a conventional C-arm fluoroscope is equipped with stepping motors. The software component allows the surgeon to control the motorised movements of the fluoroscope. The MEPUC interface enables the surgeon to position the C-arm fluoroscope independently in the operating room. Further advantages are achievable when the MEPUC interface is combined with surgical navigation, as this combination allows fully automatic reproduction of former projections. Clinical experience with the MEPUC interface suggests that the work flow for intraoperative imaging is improved and personal requirements reduced.