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A Prospective Comparison of Large vs Mini C-Arm Fluoroscopy and Resultant Eye Radiation Exposure
REFERENCES 1. Kadry B, Chu LF, Kadry B, Gammas D, Macario A. Analysis of 4999 online physician ratings indicates that most patients give physicians a favorable rating. J Med Internet Res. 2011;13(4):e95. 2. Emmert M, Meier F, Heider AK, Durr C, Sander U. What do patients say about their physicians? An analysis of 3000 narrative comments posted on a German physician rating website. Health Policy. 2014;118(1):66e73. 3. Hanauer DA, Zheng K, Singer DC, Gebremariam A, Davis MM. Public awareness, perception, and use of online physician rating sites. JAMA. 2014;311(7):734e735. 4. Bakhsh W, Mesfin A. Online ratings of orthopedic surgeons: analysis of 2185 reviews. Am J Orthop (Belle Mead NJ). 2014;43(8):359e363. 5. Rozental TD, George TM, Chacko AT. Social networking among upper extremity patients. J Hand Surg Am. 2010;35(5):819e823.e1. 6. Curry E, Li X, Nguyen J, Matzkin E. Prevalence of internet and social media usage in orthopedic surgery. Orthop Rev (Pavia). 2014;6(3):5483.
ORIF distal radius fractures, removal of hardware, closed reduction and percutaneous pinning of metacarpal and phalangeal fractures. Average monthly mini C-arm radiation output: dose rate: 4.682.09 mGy/sec, total accumulated dosage: 10.584.86 mGy, and total exposure time: 38.626.83 sec. Average monthly Large C-arm radiation output: dose rate: 2.941.90 mGy/sec, total accumulated dosage: 5.444.27 mGy, and total exposure time: 42.567.99 sec (Fig. 1). For both Large and mini C-Arm Fluoroscopy, average monthly eye radiation exposure was undetectable (<30 mrem). These values were significantly less than the previously reported maximum radiation dosage to the eye (1,250 mrem/month). Summary Points: Routine use of protective lead lining eyewear among Hand surgeons remains rare. No significant differences in eye radiation exposure were noted between Large or mini C-Arm use, suggesting that accumulated eye radiation dosage does not approach previously reported levels of critical radiation loads. Further investigation into C-arm radiation exposure may validate the safety associated with its routine use during Hand Surgery.
PAPER 36
PAPER 37
Clinical Paper Session 06: Practice Management Friday, September 11 11:39e11:46 AM Hand and Wrist
Clinical Paper Session 06: Practice Management Friday, September 11 11:46e11:53 AM Evaluation/Diagnosis, Treatment, Prognosis/Outcomes, Hand and Wrist, General Principles
A Prospective Comparison of Large vs Mini C-Arm Fluoroscopy and Resultant Eye Radiation Exposure Level 4 Evidence
Mark L. Wang, MD, PhD C. Edward Hoffler II, MD, PhD Asif M. Ilyas, MD William H. Kirkpatrick, MD Pedro K. Beredjiklian, MD Charles F. Leinberry, MD Hypothesis: The WHO recognizes cataract as the most prevalent eye disease in the world, and the association of eye radiation exposure with the premature development of cataracts has been reported. The current concept in the pathogenesis of radiation-induced cataract formation suggests elevated radiation levels lead to the generation of reactive oxygen species and increased DNA damage at the lens epithelium, resulting in cataractous lens. During routine Hand Surgery, fluoroscopic radiation exposure is a potential occupational health hazard, given operator proximity and the relative lack of eye shielding. The purpose of this study is to 1) perform a prospective comparison of Large versus mini C-Arm Fluoroscopy and resultant eye radiation exposure, and 2) test the Hypothesis that mini C-Arm use yields lower radiation loads, which do not exceed the critical eye radiation dosages associated with cataractogenesis. Methods: Over a six month period, eye radiation exposure was measured in a Board-Certified Hand Surgeon (CFL) utilizing both Large and mini C-Arm fluoroscopy during routine surgical procedures. Eye dosimeters were secured to surgical loupes at the level of the orbit. Specific dosimeters were designated for Large and mini-C-Arm use. Accumulated radiation dosage was analyzed and compared to control badges on a monthly basis, and background exposure was eliminated (Landauer). For each procedure, radiation output was logged, including the dose rate, total accumulated dosage, and total exposure time. Results: During the collection period, 38 cases used Large C-Arm fluoroscopy, and 11 cases used the mini C-Arm. Common procedures included e26
Care Transfers for Patients with Upper Extremity Trauma: Does Insurance Matter? N/A - Not a clinical study
Elham Mahmoudi, PhD Lee Squitieri, MD, MS Brianna Maroukis, BA Kevin C. Chung, MD, MS Jennifer F. Waljee, MD, MS Hypothesis: Despite federal legislation, wide variation persists in the referral patterns of upper extremity trauma patients. We sought to understand the differences in transfer rates for patients with upper extremity trauma by hospital trauma center designation, and hypothesized that uninsured and underinsured patients are more likely to be transferred to another facility compared with privately insured patients. Methods: Trauma centers are designated by local authorities and verified by the American College of Surgeons. Using the 2012 National Trauma Data Bank, we examined the probability of a patient with isolated upper extremity trauma to be transferred from one center to another. We used multivariable logistic regression to compare risk-adjusted transfer rates for patients with upper extremity injuries by trauma center designation and clustered variance method to adjust for intra-hospital correlation. Results: In 2012, 6,295 adult patients ages 18-64 with isolated upper extremity trauma presented to 477 hospitals. Overall, transfer rates were significantly higher among level III trauma centers (26%) compared with level I (2%) or level II (11%) trauma centers (P < 0.001). Adjusting for patient and hospital characteristics, patients with public insurance were more likely to be transferred from level III trauma centers to another center (OR¼1.76, CI: 1.07-2.88) compared with being privately insured. Summary Points: Underinsured patients with upper extremity trauma injuries were more likely than privately insured patients to be transferred from level III trauma centers.
ORIF distal radius fractures, removal of hardware, closed reduction and percutaneous pinning of metacarpal and phalangeal fractures. Average monthly mini C-arm radiation output: dose rate: 4.682.09 mGy/sec, total accumulated dosage: 10.584.86 mGy, and total exposure time: 38.626.83 sec. Average monthly Large C-arm radiation output: dose rate: 2.941.90 mGy/sec, total accumulated dosage: 5.444.27 mGy, and total exposure time: 42.567.99 sec (Fig. 1). For both Large and mini C-Arm Fluoroscopy, average monthly eye radiation exposure was undetectable (<30 mrem). These values were significantly less than the previously reported maximum radiation dosage to the eye (1,250 mrem/month). Summary Points: Routine use of protective lead lining eyewear among Hand surgeons remains rare. No significant differences in eye radiation exposure were noted between Large or mini C-Arm use, suggesting that accumulated eye radiation dosage does not approach previously reported levels of critical radiation loads. Further investigation into C-arm radiation exposure may validate the safety associated with its routine use during Hand Surgery.
PAPER 36
PAPER 37
Clinical Paper Session 06: Practice Management Friday, September 11 11:39e11:46 AM Hand and Wrist
Clinical Paper Session 06: Practice Management Friday, September 11 11:46e11:53 AM Evaluation/Diagnosis, Treatment, Prognosis/Outcomes, Hand and Wrist, General Principles
A Prospective Comparison of Large vs Mini C-Arm Fluoroscopy and Resultant Eye Radiation Exposure Level 4 Evidence
Mark L. Wang, MD, PhD C. Edward Hoffler II, MD, PhD Asif M. Ilyas, MD William H. Kirkpatrick, MD Pedro K. Beredjiklian, MD Charles F. Leinberry, MD Hypothesis: The WHO recognizes cataract as the most prevalent eye disease in the world, and the association of eye radiation exposure with the premature development of cataracts has been reported. The current concept in the pathogenesis of radiation-induced cataract formation suggests elevated radiation levels lead to the generation of reactive oxygen species and increased DNA damage at the lens epithelium, resulting in cataractous lens. During routine Hand Surgery, fluoroscopic radiation exposure is a potential occupational health hazard, given operator proximity and the relative lack of eye shielding. The purpose of this study is to 1) perform a prospective comparison of Large versus mini C-Arm Fluoroscopy and resultant eye radiation exposure, and 2) test the Hypothesis that mini C-Arm use yields lower radiation loads, which do not exceed the critical eye radiation dosages associated with cataractogenesis. Methods: Over a six month period, eye radiation exposure was measured in a Board-Certified Hand Surgeon (CFL) utilizing both Large and mini C-Arm fluoroscopy during routine surgical procedures. Eye dosimeters were secured to surgical loupes at the level of the orbit. Specific dosimeters were designated for Large and mini-C-Arm use. Accumulated radiation dosage was analyzed and compared to control badges on a monthly basis, and background exposure was eliminated (Landauer). For each procedure, radiation output was logged, including the dose rate, total accumulated dosage, and total exposure time. Results: During the collection period, 38 cases used Large C-Arm fluoroscopy, and 11 cases used the mini C-Arm. Common procedures included e26
Care Transfers for Patients with Upper Extremity Trauma: Does Insurance Matter? N/A - Not a clinical study
Elham Mahmoudi, PhD Lee Squitieri, MD, MS Brianna Maroukis, BA Kevin C. Chung, MD, MS Jennifer F. Waljee, MD, MS Hypothesis: Despite federal legislation, wide variation persists in the referral patterns of upper extremity trauma patients. We sought to understand the differences in transfer rates for patients with upper extremity trauma by hospital trauma center designation, and hypothesized that uninsured and underinsured patients are more likely to be transferred to another facility compared with privately insured patients. Methods: Trauma centers are designated by local authorities and verified by the American College of Surgeons. Using the 2012 National Trauma Data Bank, we examined the probability of a patient with isolated upper extremity trauma to be transferred from one center to another. We used multivariable logistic regression to compare risk-adjusted transfer rates for patients with upper extremity injuries by trauma center designation and clustered variance method to adjust for intra-hospital correlation. Results: In 2012, 6,295 adult patients ages 18-64 with isolated upper extremity trauma presented to 477 hospitals. Overall, transfer rates were significantly higher among level III trauma centers (26%) compared with level I (2%) or level II (11%) trauma centers (P < 0.001). Adjusting for patient and hospital characteristics, patients with public insurance were more likely to be transferred from level III trauma centers to another center (OR¼1.76, CI: 1.07-2.88) compared with being privately insured. Summary Points: Underinsured patients with upper extremity trauma injuries were more likely than privately insured patients to be transferred from level III trauma centers.