Mini C-arm question

[sinustarsi]

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Do I need to wear lead for the mini C-arm? I bought some eye leaded shield for $250. OUCH! I wish they can make surgical lead gloves as my hands also seem to be hit here and there when holding the foot. Thyroids/other glands seem to be affected with the large C arm but what about the Mini C arm? Any Ideas?

 

[jonwill]

Do I need to wear lead for the mini C-arm? I bought some eye leaded shield for $250. OUCH! I wish they can make surgical lead gloves as my hands also seem to be hit here and there when holding the foot. Thyroids/other glands seem to be affected with the large C arm but what about the Mini C arm? Any Ideas?

Large C-Arm
When the specimen was positioned within 2 in of the radiation source (the worst-case configuration), scatter exposure was captured by dosimeters on the platform, on the x-ray-source side, and on the image-intensifier side (Table I). When the specimen was in the 10-in position, scatter radiation was detected by dosimeters positioned on the platform and on the image-intensifier side. When the specimen was positioned in the best-case configuration, scatter was recorded only by dosimeters mounted on the platform (14 and 17 mrem [0.14 and 0.17 mSv]). Less than 10 mrem of exposure was recorded by the dosimeters in the x-ray-source and image-intensifier positions. It is important to note that if a dosimeter measured <10 mrem, a value of 0 mrem was assigned and noted in this manner on the occupational radiation exposure report that was returned to us.

Mini C-Arm
Considerably less exposure was detected when the testing configurations were repeated with the mini c-arm. Only when the specimen was brought within 2 in of the x-ray source did the peripheral dosimeters record any measurable radiation. The exposure levels were 15 and 18 mrem (0.15 and 0.18 mSv) at the platform position (Table II). In the best-case and 10-in configurations, <10 mrem of exposure was recorded by the peripheral dosimeters at all mounted positions.

J Bone Joint Surg Am. 2009 Feb;91(2):297-304.

 

[krabmas]

I wear lead whenever x-ray mini or otherwise is used in the room.

radiation exposure is cumulative and causes cancer not just infertility/birth defects.

 

[minicarm]

yes anytime using a Mini C-Arm you should be using a lead vest - at max power there is very little to no scatter though when youre 3' away

 

[GreenHousePub]

I know that a lot of people don't but I personally do. I also use lead protective goggles because I want to fight against cataracts/melanoma of the eye.

 

[Pronation]

I use a leaded banana hammock.

 

[Adam Smasher]

if only we knew in 2010 what we know now...

 

[DarkPathMedicine]

Yes! Any radiation, no matter how large or small, is increased risks for exposure and can cause long-term effects. It's cumulative over time and time is something we don't have much of in life.

 

[HardRoadPaved]

Anyone covering their brain properly?

 

[Feli]

You don't really need eye protect if you just use a face shield mask, as you should for any surgery with power, irrigation, amp, etc (so any F&A surgery). Even the thin clear shield attached to the mask or as OR glasses cuts any tiny bit of scatter rad significantly (over half).

Personally, I just use thyroid shield for mini or large c-arm. The above research jonwill had posted has been repeated a few times with same results. With large C-arm, I might do lead vest if it's a longer case (trauma or something with a lot of position checks or a "go live" portion). It is distance and time for rad protection, and my time is basically zero on most stuff, though.
For most cases I do, I am shooting 1 or 2 or 3 shots for 0.0x second pictures at the end (check the reduction or lag screw or pin or fusion position, then shoot a final or two before closing (which I can step way back on).
Also, I do maybe avg 5 surgery cases that need XR per month and 3-5 that don't. My c-arm time in a year is amost certainly under one minute (a few traumas using 2-5sec per year, the rest elective and basic ankle fx well under 1sec flouro). My dosimeter is basically undetectable, even in residency with daily surgery.

It might be different for newer attendings or ppl who like to use a lot of c-arm time and like to use a lot of cannulated screws or check things frequently? I notice teaching attendings also use a lot more flouro time than non-teaching. I think the generation who did solid screw and visualizing reduction/position is different from the one that wants cannulated everything and jigs for everything. I was a bit of a tweener in that training regard, but always I lean to a good looking bunion visually over taking 10 pics to decide the translation/position. Solid screws are also a lot stronger and cheaper (at the sizes podiatry uses).
It'd also be different for someone who does surgery almost every day or a lot of RRA/trauma that's XR heavy (a few hospital DPMs, ortho group DPMs, residents and fellows).
It might be much different for a female DPM as males get new gametes every few days while women have all of theirs and, as mentioned, rad is cumulative. That is not unwise to use vest even for mini C.

If anything, surgeons who do a ton of live manips (hand surgery, IR, spine, cath docs, etc) should use the rad-block gloves, double glove, etc. That cylinder of energy (even mini-C) is where the appreciable exposure is from every study.

...I really think we go a little overboard in podiatry sometimes and over-estimate our own importance: five-page op reports, quad scrubbing, more lead than most orthos or onco surgeons, OR caps in the hospital cafe, five acronyms after DPM. Because podiatry. 🙂

 

[billBOB213]

That last paragraph

When I was on vascular & general surgery rotations as a resident I remember seeing their op reports ….and realizing that I was usually going way overboard on mine.

 

[Feeter]

You should wear led if you are scrubbed in and using x ray. For any ex fix cases I wear led gloves because I am usually holding or pulling things during x rays and sometimes they get my hand in it.

At my workplace we also apply led to pts if we are using big c arm

 

[GreenHousePub]

 

[Hybrocure]

I only wear lead for the big C arm. To be honest my flouro usage is so low as an attending now compared to residency that it is hardly an issue. I feel that whatever damage could’ve happened from radiation likely already occurred in residency and I can’t do anything about it now. I definitely had days in residency where I walked out of some attendings cases glowing green.

 

[deleted1162946]

Lead absolutely kills my back. It's tough deciding on wanting cancer or a ****ed up back.

 

[DYK343]

Im kind of a radiology safety nerd. Worked in a lab in college with some emphysis on this.

There is some misinformation above.

Ionizing radiation is cumulative only in some areas - like the eyes. Its actually somewhat quantifiable here. Once you reach a certain threshold your eyes start to fog over with cataracts. This is referred to as non-stochastic radiation dose.

But for random organs and cells its not cumulative. All it takes is for the xray to hit the right DNA strand at the right spot and it could lead to cancer. Stochastic affect is the terminology.

DNA is super small. So are Xray beams. But any radiation could be a techinically fatal dose if it hits the DNA in the right spot. The higher the dose the higher the chance of a perfect hit. But even a small dose can be all it takes. Luckily even if it does happen apoptosis exists and our bodies typically destroy the cancerous cells.

On a board exam the answer is "there is no safe dose" to any question asked.

Also, lead gloves are dumb. It drastically increases the scatter radiation because the C arm recognizes the lead and increases the xray output because it wants to make a clear image based on density. This drastically increases the operator exposure and the patient exposure. Keep hands out of the beam and dont wear leaded gloves.

I lead up for small and large C arms. Full gown and thyroid shield.

I dont wear glasses because they are heavy, fog over on me, and the vision is blury.

If anyone has any recommendations for a pair that dont do this I might snag some.

 

[DYK343]

View attachment 372657

yeah im not so sure about the faceshield idea.
Any literature to back this up @Feli

 

[DYK343]

Also I think we got triggered by a mini C arm bot to sell mini C arms.

 

[Feli]

yeah im not so sure about the faceshield idea.
Any literature to back this up @Feli

I think it's mostly just common sense from what we know of rad and materials.
Putting something - almost anything - between the person/sensor/etc and the XR source will block some.
Eyeglasses give better protect than nothing (although I'm sure the rad safety glasses sellers will say they're 100% inadequate).

Concrete, lead, water are proven. Many other metals and rocks do an ok job but are or less effective or too expensive.
Glass with lead added or acrylic with a bit of lead is proven (lead glasses fad).
We know acrylic/plastic blocks UV, IR, micro and all kinds of other radiation which we can measure better than XR.
We know thicker clear acrylic shields (wall-on-wheels types that XR depts use) block a high % of ionized XR rads.

I don't think the thin eye/face shield acrylic layer between surgeon eyes and mini-C will increase exposure. That's for sure.
Everything common sense says it'd do what it does to UV, IR, etc... but we may not know in our lifetime (since scatter XR can't be detected more than a half arm's reach from mini-C arm anyways).

It's always fine to be safe... won't hurt anything.
Most DPMs use less flouro time in a lifetime than many IR and ortho docs use in a week or two, though.
Luckily, we don't see every retired ortho and GI doc blind and covered with face neoplasms, even though their older c-arms were much more leaky.

 

[DYK343]

I think it's mostly just common sense from what we know of rad and materials.
Putting something - almost anything - between the person/sensor/etc and the XR source will block some.

Concrete, lead, water are proven. Many other metals and rocks do an ok job but are or less effective or too expensive.
Glass with lead added or acrylic with a bit of lead is proven (lead glasses fad).
We know acrylic/plastic blocks UV and all kinds of other radiation which we can measure better than XR.
We know thicker acrylic shields (wall-on-wheels types that XR depts use) block a high % of ionized XR rads.

I don't think the thin eye/face shield acrylic layer between surgeon eyes and mini-C will increase exposure. That's for sure.
Everything common sense says it'd do what it does to UV, IR, etc... but we may not know in our lifetime (since scatter XR can't be detected more than a half arm's reach from mini-C arm anyways).

It's always fine to be safe... won't hurt anything.
Most DPMs use less flouro time in a lifetime than many IR and ortho docs use in a week or two, though.
Luckily, we don't see every retired ortho and GI doc blind and covered with face neoplasms, even though their c-arms were much more leaky.

Xrays and UV light are different waveforms but also similar. Should do a study to see if wearing polarized glasses or glasses in general helps.
Or ask a physicist and not some guy who partied in college and had to go to DPM school.