Radiation Dose Assessment of the Fog Lead Acrylic Shields during Coronary Angiography: A Phantom Study

This study aimed to evaluate the effects of fogging on the effectiveness of a lead glass shield in protecting an operator from radiation exposure during conventional coronary angiography (CAG). Optically stimulated luminescence dosimeters (OSLDs) were used to measure the effects of fogged lead glass shields (FLSs) and clear lead glass shields (CLSs) on the radiation doses of a cardiac catheterization surgeon. We simulated the scatter radiation incident on the operator with five angiographic projections with 10-s exposures. Experiments were conducted with a field of view of 25 cm, maximum of 100 cm between the X-ray tube and image intensifier, and 80 cm between the image intensifier and operator. Lead glass fogging had no significant effect at any angiographic projection. The average dose at the lens of the eye, thyroid glands, and gonads did not differ significantly between FLS and CLS. Although most surgeons view ceiling-suspended shields as hindrances during surgical procedures, the radiation dose at the operator’s eyes and thyroid glands increased by 13 and 10 times without the shield. The fogging of the shield is probably caused by post-surgery UV decontamination or detergents. An operator has no cause for concern regarding the radiation protection afforded by an FLS during CAG procedures.

Radiation Protection Evaluations Following the Installations of Two Cardiovascular Digital X-ray Fluoroscopy Systems

Acceptance testing and commission are essential elements of the quality assurance program for imaging equipment. We present the results of a performance evaluation of Flat Panel-Based Cardiovascular Fluoroscopy X-ray Systems as a part of acceptance testing and commissioning. Measurements were obtained using a calibrated dose rate meter, patient equivalent phantoms, and Leeds image quality test tools. The results were compared with the manufacturer and European acceptability criteria. The entrance surface air kerma (ESAK) rate ranged from 8.0 to 12.0 mGy min−1 in the continuous mode and from 0.01 to 0.04 mGy fr−1 in the pulsed mode of operation. Detector-input air kerma rates ranged from 0.29 to 0.39 mGy min−1 in continuous mode and from 0.02 to 0.07 µGy fr−1 in pulsed mode. Fluoroscopy device half-value layer (HVL) ranged from 2.5 to 3.0 mm Al, and the low resolution ranged from 0.9 to 1.3%. The spatial resolution limit was double that of the image intensifier (2.4 to 3.6) lp/mm. Flat-panel fluoroscopy demonstrated superior image quality and dose performance as compared to conventional image intensifier-based fluoroscopy. The quality assurance measurements presented are essential in the rapid evaluation of the imaging system for acceptance testing and commissioning.

Endonasal Endoscopic Approach to Sphenoid Sinus Lesion

Background: Anatomical position of sphenoid sinus, sellar and parasellar regions are located in the skull base having difficulty to approach due to presence of vital structures in its proximity. The presence of carotid artery and optic nerve in its lateral wall make the situation difficult due to lack of illumination and visual limitation. In the past traditional techniques to approach this region like external ethmoidectomy, transseptal transsphenoidal routes were used causing significant trauma, bleeding and risk of possible complication in skull base region. Aim: to access the efficacy and safety of the endonasal endoscopic approach to the sphenoid sinus Method: This study was done in the department of ENT Shaikh Zayed hospital Lahore, 33 patients who were diagnosed to have lesions involving sphenoid sinus. Detailed history, thorough ENT examination, relative investigations were done and all were managed naso-endoscopically. Results: The review of these cases showed that the endoscopic technique was found to have the advantages of being minimally invasive with no external incisions. There is less trauma to the patient, no need for operating microscope or intraoperative image intensifier. Conclusion: The conclusion of our study showed that naso-endoscopes are excellent tools for better visualization due to availability of different angled scopes and good illumination. The disease is better assessed and cleared identifying landmarks with quicker postoperative recovery and lesser overall morbidity. Over the last few years, endoscopic approach to these regions has gained much popularity because of advances in optics, endoscopes and illumination. Keywords: Endoscopic sinus surgery, sphenoid sinus

942 Outcome of Image Guided Intra-Articular Thumb Base Steroid Injections-Retrospective Study of Consecutive Patient Over 4 Years in A Plastic and Hand Surgery Unit in West Lothian, Scotland

Introduction Osteoarthritis of the thumb base is a common condition. Usually effects the elderly population causing significant disability. Modalities of treatment of osteoarthritis which includes conservative measures, non-operative interventions, and surgery. In this study we endeavored to assess how effective are image guided steroid injections for base of thumb Osteoarthritis as assessed by subjective pain relief perceived by patient and what percentage of these patients proceed to operative treatment. Method Retrospective data between January 2015 and December 2018 of the patients who underwent Steroid injections to the Base of thumb joints (CMCJ and/or STTJ) for Osteoarthritis under image intensifier guidance was collected from Hospital management system –TRAK and eHealth services. Follow up of the patients were done for Maximum 1 to 5 years. Results A total number of 692 patients with thumb base osteoarthritis were included in the study of which 546 patients underwent Image guided steroid injection to the thumb base. The mean Age of patients was 64.5 years and the Female: Male ratio was 401:145. Mean number of injections each patient received- 3.25 (1 – 7 times). Pain relief after first, second and third injections were 3.15 months, 2.63 and 1.75 months, respectively. 127 (23.2% of injections patients) underwent trapeziectomy. Mean time between first injection & Surgery was 1.3yrs (6 months -2 years) Conclusions This study demonstrates the effectiveness of image guided steroid injections for thumb base osteoarthritis. Though about a quarter of these patients proceed to operative management, steroid injections can delay the same considerably.

859 Follow up of distal radius volar plating – No role for post-operative radiographs

Aim There is no consensus on the follow up for distal radius fractures after fixation. All patients receive intra-operative image intensifier screening to check the adequacy of reduction and implant position. We propose that if a patient is asymptomatic, you do not require post-operative radiographs. Method We conducted a retrospective review of all distal radius fractures operated in our hospital over the last 10 years. Data was collected from electronic records for revision surgery or metalwork removal. Records were assessed for patient symptoms, radiographic findings, and indications for implant removal. Patients had a minimum follow up of 6 months. Results 900 distal radius fixations were performed over a 10-year period, of which 747 were volar plating. 49 patients had volar plates removed. 14 patients had metal work removal and joint release for stiffness. 6 had the plate removal and carpal tunnel neurolysis with release. 11 implant removals for screw prominence. Other operative indications included reduction failure (n = 2), infection (n = 2) and removal in paediatric patients (n = 3). 47 of the 49 patients for implant removal were symptomatic at follow up. Only two patients had implant removal following isolated radiographic evidence of metalwork mal position. Conclusions Intra-operative intensifiers reduce the risk of implant and fixation errors. Routine post-operative radiographs altered the management of only 2 out of 700 (0.3%) patients. We suggest that radiographs have no role in routine post-operative care of distal radius fractures, where patients are asymptomatic with appropriate intra-operative intensifier images.

AWARENESS OF RADIATION HAZARD IN ORTHOPAEDIC RESIDENTS SURGEON IN A CENTRAL INDIA

One of the effective techniques which has evolved in contemporary orthopaedic practice is C-arm fluoroscopy in intra-operative orthopaedic procedures. Such techniques improve the competence of the surgeon while reducing the jejuneness and duration of the patients stay at hospital. Although having awareness about reported benefits of the device, there is increasing worry over the surgical teams elevated radiation exposure. The current research was undertaken on orthopaedic surgeons working in the region of Central India to assess the amount of radiation exposure if they follow the normal precautionary steps as well as to raise awareness and encouraging them to use the image intensifier safety in daily practice. In addition, to raise concerns of radiation safety and the befitting use of radiation in the operating room.Materials and Method: This is an observational review of data gathered by residents performing common orthopedic surgical operations in emergency and routine OT during one-year residency at a medical college hospital. We calculated the mean radiation exposure on each resident (orthopedic resident postgraduate-3yr) with and without lead apron protection, and compared it with the ICRP limit for radiation to body per year between 1st January 2020 and 31st December 2021.Result: Total radiation levels accumulated by one resident without lead apron over 1 year was calculated (35.88 milliSv). which was greater to ICRP limit for radiation to body per year (20milliSv).Total radiation levels accumulated by one resident with lead apron over 1 year was calculated (2.04 mSv).which was less than ICRP limit for radiation to body per year (20mSv).Conclusion: Orthopedic resident surgeons are not listed as Radiation personnel. Radiation toxicity, in addition to the risks of other surgical industries, is therefore an additional occupational danger. As a result, orthopedic resident surgeons should be concerned. During surgeries, junior orthopaedic residents vastly underestimate their level of radiation. They should adhere to the guidelines outlined above. The conventional assertion that radiation exposures during c arm use are negligible and should be disregarded, as the long-term adverse biological effects of continuous low-dose radiation exposure are uncertain at this time. Theres a chance of cancer, as well as genetic variations and fertility complications.

Removal of a broken dental needle in the pterygomandibular space using an image intensifier: two case reports

Introduction: Accidents and complications are elements that can occasionally be associated with the procedures realized within work dentist environment. Among some accidents related to dental practice, needle fracture during local anesthesia is noteworthy due to its rarity. Objective: This work seeks to report two cases of removal of a broken dental needle in the pterygomandibular space using an image intensifier. Material and Methods: In both cases, the accident happened during an inferior alveolar nerve block. The surgeons requested image exams to locate the objects using general anesthesia. In the surgery, a transoral incision was made to remove the broken needle from the pterygomandibular space, guided by an image intensifier. Results: Both surgeries were a success. The broken needles were found quickly with the use of the image intensifier, and no postoperative complications were observed. Conclusion: The correct assessment of fractured dental position is essential for its removal. The use of the image intensifier has been showing advantages, such as offering fast transoperative dynamic images and at different angles, thus providing opportunity for calmer surgery and with less risk for the patient and the operator.

Radiation in orthopaedics (RIO) study: a national survey of UK orthopaedic surgeons

Objectives: Orthopaedic surgeons have a responsibility to minimise risks of ionising radiation to patients, themselves and staff. This study aims to establish the understanding of radiation practice, legislation and risk by orthopaedic surgeons. Methods: A nationwide online survey of UK-based orthopaedic surgeons was conducted. Participants answered eighteen multiple-choice questions assessing level of radiation safety training, basic principles/knowledge of ionising radiation, relevant legislation and operating practice. Results: A total of 406 surgeons completed the survey. 92% reported using intra operative ionising radiation at least once per week. 38% received no formal training on radiation safety. Knowledge of basic principles of radiation and legislation was limited. There was variable knowledge when labelling an image intensifier machine and choosing its safest orientation. Poor uptake of radiation protection equipment was noted. Only 19% agreed they had adequate training in ionising radiation safety and 27% reported receiving adequate training in equipment emitting ionising radiation in the operating theatre. Conclusion: Many orthopaedic surgeons in the UK do not believe they are adequately trained in radiation safety. There is a deficiency amongst practicing surgeons in basic knowledge, relevant legislation and practicalities of the use of ionising radiation in the operating room. This could potentially put patients and healthcare professionals at additional risk. We recommend that a standardised national training programme on the basic principles and safety of ionising radiation is implemented for all practicing orthopaedic surgeons. Advances in knowledge: This paper is the first UK national survey amongst orthopaedic surgeons and is one of the largest reported internationally.

Genu valgum deformity – correction by a wedgeless implantless femoral “V” osteotomy

Coronal malalignment of the knee joint is very common in developing countries especially because of nutritional rickets. Significant valgus deformity needs to be treated surgically to improve appearance, gait and function of the patient. The purpose of this prospective study was to evaluate the results of supracondylar “V” osteotomy as a surgical technique for correction of the valgus knee deformity. This study was conducted in a tertiary level teaching hospital and 30 cases were included in the study. For all the patients deformity was assessed using ana- tomical tibiofemoral angle, mechanical axis deviation and intermalleolar distance preoperatively and post- operatively. The average age of our patients was 13.7 years and the average follow up was3.29 years (1.39-14.22 yrs). Clinically the average value of intermalleolar distance preoperatively was 16cm and 3.2 cm postperatively. Average pre-operative tibiofemoral angle was 23° and the average postoperative angle was 6 0 which was found to be statistically significant using the Paired t test (p<0.005). The average value of preoperative mechanical axis deviation was 3.1 cm which decreased to an average value of 1.1 cm postoperatively. The results with this technique have been encouraging. The advantages of this technique are low morbidity, good stability allowing early ambulation, ability to adjust alignment postoperatively by casting and no need for internal fixation. Few studies have been conducted on osteotomies that do not require internal fixation and are inherently stable. This technique has the advantage of practically no occurrence of any infection or a second surgery to remove hardware in children and adolescents. Since no specialized instrumentation, image intensifier and implants are required, it is cost effective and can be used in any primary care or district level surgical setup in a developing country like ours.

Comparison of fluoroscopy time in short and long cephalomedullary nailing for 31A2 intertrochanteric hip fractures

There is no study that has compared the radiation exposure during short (Short PFN) and long proximal femoral nailing (Long PFN) for 31A2 intertrochanteric hip fractures. The objective of the present study was to compare the radiation exposure time in short and long proximal femoral nail during the treatment of 31A2 intertrochanteric hip fractures. This prospective cohort study was carried out in a University teaching hospital. Sixty one consecutive patients with 31A2 intertrochanteric femur fracture treated with pro- ximal femoral nail were included in the study. The distal locking in the short PFN was performed using the locking zig and distal locking in the long PFN was performed using the free hand perfect circle technique. The same mobile image intensifier (Multimobil 5E, Siemens, Erlangen, Germany) was used in the entire study. The outcome measure was the fluoroscopy exposure time (seconds) which was measured directly from the image intensifier. Thirty patients underwent fixation with short PFN and 31 patients underwent fixation using long PFN. The mean fluoroscopy exposure time in short PFN cohort was 189.5 seconds ± 26 (range : 150-250 seconds) and the mean fluoroscopy exposure time in long PFN cohort was 283.4 seconds ± 43.8 (range : 200-400 seconds). The mean fluoroscopy exposure time was 93.9 seconds shorter in the short PFN cohort and this difference was statistically significant (p < 0.0001 ; 95% CI : 75.4 to 112.3). The radiation exposure to the operating team is significantly less during treatment with short PFN in 31A2 intertrochanteric fractures.