Analysis of radiation risk to patients from intraoperative use of the mobile X-ray system C-arm

Background: The aim of this study was to investigate clinical applications of mobile C-arms and consequent radiation risk, to increase medical attention on radiation protection, and to provide basic data for safe radiation use in the operating room. Materials and Methods: In this study, a total of 374 surgical operations, conducted using a portable fluoroscopic X-ray system from January to March of 2013, were analyzed. Dose summaries produced by the General Electric C-arm and data elements in digital imaging and communications in the medicine header of Ziehm C-arm, fluoroscopy time were used to obtain dose-area product (DAP) and effective dose. Corresponding mean and maximum values were calculated, and the resulting data on the frequency of application, fluoroscopy time, DAP, and effective dose were compared and analyzed in terms of surgical specialty and operation types. Results: Orthopedic surgery was the most frequent with 165 cases (44.1%). The highest DAP value and effective dose were found in liver transplant among surgical specialty fields, with mean values of 2.90 ± 3.76 mGy∙m2 and 58 ± 75.2 mSv, respectively (P = 0.0001). The highest DAP value and effective dose were observed in intra-operative mesenteric portography among types of surgery, showing mean values of 2.90 ± 3.81 mGy∙m2 and 58.03 ± 76.24 mSv, respectively (P = 0.0001). Conclusion: Because DAP varies significantly across surgical specialties and types of operation, aggressive efforts to understand the effects of radiation dose is critical for radiation protection from intra-operative use of mobile C-arms.