Using mindful behavior to reduce fluoroscopic time and radiation in motorized internal femur lengthening

Abstract

Introduction: Fluoroscopic imaging is universally employed by orthopedic surgeons in the operating room. Nonetheless, intraoperative radiation exposure has an appreciable risk for patients and operating room personnel. Mindful practice of limiting fluoroscopic shots by the operating surgeon can be a useful tool for minimizing dose-dependent radiation. Methods: Ten consecutive patients (20 limbs) undergoing bilateral femoral lengthening osteoplasty with insertion of an intramedullary lengthening nail at the study institution were selected. Intraoperative imaging from one group (control) consisting of five patients (10 limbs) who underwent the standard procedure was retrospectively reviewed. The second group (image conscious) consisted of five patients (10 limbs) who underwent the procedure while a conscious effort was made to reduce the number of extraneous fluoroscopic images. Fluoroscopic images were logged for quantity and time stamps. One-tailed Student's t-test was used to compare the control group to the image-conscious group with a statistical significance level set to P < 0.05. Results: The number of fluoroscopic images acquired in the image-conscious group (61.2 ± 11.1) compared to the control group (112.6 ± 20.6) showed a statistically significant decrease (P = 0.006). The amount of radiation dosage absorbed in the image-conscious group (6.82 mGy ± 1.8) compared to the control group (9.89 mGy ± 2.7) was also statistically significant (P = 0.037). The average total operative time per limb in the control group was 103 min (±15) versus 106 min (±12) in the image-conscious group (P = 0.399). There was no significant difference between the groups for age, body mass index, nail diameter, or nail length. There were no intraoperative complications or need for revision surgery in either group. Discussion: Image-conscious fluoroscopy leads to a 45.7% reduction in radiation dosage with a statistically significant decrease in the number of images taken, absorbed dosage, and fluoroscopic imaging time in a standardized procedure without increasing operating room time or perioperative complications. Conclusion: Orthopedic surgeons have the potential to minimize the adverse effects of radiation exposure in the operating room by being mindful about avoiding excessive fluoroscopy shots.

Keywords

• c-arm
• intramedullary lengthening
• intraoperative fluoroscopy
• mindfulness
• radiation