Typical Air Kerma Area Product Values for Trauma Orthopaedic Surgical Procedures

BACKGROUND: The aim of study was to establish the typical radiation quantity values for the most common trauma orthopaedic surgical procedures and to compare them with reference values of equivalent procedures performed in other institutions. In addition, we assess the impact of image intensifier and flat panel detector technology used for fluoroscopically guidance on patient exposure. MATERIALS AND METHODS: Five most frequently performed fluoroscopically guided trauma orthopaedic procedures in University Medical Centre Ljubljana were analysed. Data on 199 cases over a 6 months period from December 2016 to June 2017 were gathered retrospectively. Study covered 40 dynamic hip screw fixations (DHS), 23 proximal femoral nail insertions (PFN), 20 proximal humeral nail insertions (PHN), 77 partial hip endoprosthesis implantations (PEP) and 39 percutaneous posterior spine fixations (PPS). The median and average along with the first and third quartile values of air kerma area product (KAP) for each procedure type were calculated as well as median and average value of fluoroscopy screening time. RESULTS: Typical KAP value for dynamic hip screw fixation was set at 0.52 Gycm(2); for proximal femoral nail insertion at 0.53 Gycm(2) and for proximal humeral nail insertion at 0.26 Gycm(2). For implantation of partial endoprosthesis typical KAP value utilizing flat panel technology was set at 0.08 Gycm(2) and at 0.21 Gycm(2) when the image intensifier technology was used. Typical KAP value for percutaneous posterior spine fixation was set at 1.26 Gycm(2), using flat panel technology and at 3.98 Gycm(2) using image intensifier technology. CONCLUSIONS: Established typical KAP levels of surgical orthopaedic procedures in traumatology will serve as a valuable tool for further radiation exposure optimization.