Mini C‐arm: faster, cheaper, safer?

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Fluoroscopy is essential for fracture reduction. Children are especially sensitive to radiation exposure.1 Even diagnostic level radiation is associated with significant risk. An Australian study2 reported a 24% higher incidence of cancer in 680 000 patients exposed to a computed tomography scan before age 18. Although computed tomography doses are higher, the principle of radiation minimization remains. Staff are also affected by radiation, either direct or scattered. Mastrangelo et al.3 in one centre noted that orthopaedic surgeons had a higher incidence of cancers than age‐matched controls and non‐orthopaedic staff in theatre (odds ratio = 5.37).
Mini C‐arm image intensifiers (IIs) have been reported to have lower radiation doses to patients4 and operating personnel.5 Scatter is one or two orders of magnitude lower.4 The smaller radius of the mini C‐arm allows lower beam power and greater collimation.9 Surgical experience has been shown to be inversely proportional to radiation exposure during fluoroscopy.10
Our institution is a tertiary 300‐bed paediatric and obstetric hospital. A Fluoroscan Insight 2 mini‐C arm II (Hologic, Bedford, MA, USA) has been in operation since April 2009. The Fluoroscan is a mini C‐arm II moved and operated directly by the surgeon without a radiographer. In South Australia, orthopaedic consultants and registrars who are trained and licenced by the Environmental Protection Authority may operate the machine for imaging limbs, distal to and including the knee and shoulder. Local legislation varies in Australia and New Zealand; generally consultant surgeons can be licenced and in some states trainees also.8
Other centres have reported a 15% decrease in radiographer workload and reduced delays following introduction of a mini C‐arm II.11 A Canadian study of metacarpal fracture fixation noted that introduction of a mini C‐arm allowed 19 min shorter procedure time and 24 min shorter in‐theatre time.12
The aim of our study was to determine whether use of the Fluoroscan allows lower radiation exposure and theatre time saving. We also explored the role of operator experience.
Paediatric forearm fractures are common (413.8 per 100 000 children),13 accounting for 45% of paediatric fractures.14 The mini C‐arm has been validated for assessment of reduction of paediatric forearm fractures.15 No study comparing radiation exposure between a mini‐C arm and traditional II in a paediatric forearm fracture population has been published. Our series of over 600 cases is the largest study undertaken comparing the mini C‐arm II with a traditional II.
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