Professional Documents
Culture Documents
Submitted to
Prof. Sheila Beliran, R.N., M.A.N.
Submitted by
Melanie A. Bernardez, RN
Because training with live volunteers is not feasible in training with cadavers is
costly, current training programs are based mainly on theoretical knowledge and
are lacking in practical application. Most practical training still takes place in the
operating room, were the risk to patients and personnel alike maybe high because
of poor understanding of the pattern of radiation distribution from the c arm.
Image intensifiers have become popular due to the concept of minimally invasive
surgeries leading to decreasing invasiveness, decreased operative time, and less
morbidity. The drawback, however, is an increased risk radiation exposure to
surgeon, patient and theater staff. These exposures have been of concern due to
their potential ability to produce biological effects. The present situation was
embarked analope the amount of radiation received by orthopedic surgeons using
standard precautionary measures and also the awareness about the use of image
intensifier safety in every days practice.
The use of fluoroscopy has increased time during in field of orthopedics. The image
intensifier have enable orthopedic surgeon to become technically more proficient
and decreased the morbidity of the patient by minimizing the area of operative field
and decreasing operating time.
Fluoroscopy has been used in abused. Some over views it forgetting the principles
of radiation protection while others have unfounded fears. In general, orthopedic
surgeons lack awareness about the radiation exposure they are getting and its
effects on health. And callous with protection, surgeons and assistants are at
maximum risk among all personnel due to proximity to exposure area. Some studies
concluded that whole body receive is well within recommended level but how
implied caution due to long term effects of even low dose radiation. It is pertinent
that any amount of exposure to ionizing radiation leading to secondary occupational
risk should be avoided or maximize caution exercise to minimize the exposure.
DISCUSSION
Orthopedic surgeon and assistants are the maximum radiation risk among all
personnel due to proximity to exposure area. There was a significantly positive
correlation between operating time and exposure time. In general, close reduction
and interlocking nailing procedure were associated with a higher exposure time in
comparison to open procedures and percutaneous procedure/ closed reduction and
others.
A. Personal protection
1. Shielding all personnel should wear protective gear. Lead apron keep in
reducing the exposure by a factor of 4 inches lateral view and a factor of 16
inches postero- anterior view. Thyroid guards decrease the exposure 2.5
times the normal. Eye protection is essential and is the first determined of
work load in all procedures. Lead apron should have at least 0.5mm
equivalent thickness of lead and the goggles should be at least 0.15mm lead
equivalent thick.
2. Distance the intensity of radiation at a point is inversely proportional to the
square of distance.
4. Staffing training Many of the surgeons and staff are callous towards
radiation protection. It has been personal experience that many persons do
not wear thyroid shields. Thyroid protector leads to a further 2.5 fold
decrease of ration dose than without thyroid protector. All staff should
undergo a regular orientation program towards radiation protection.
Hospitals benefit from cost savings through fewer follow-up operations and
from minimized installation efforts. A C-arm comprises a generator (X-ray source)
and an image intensifier or flat-panel detector. The C-shaped connecting element
allows movement horizontally, vertically and around the swivel axes, so that X-ray
images of the patient can be produced from almost any angle. The generator emits
X-rays that penetrate the patient's body. The image intensifier or detector converts
the X-rays into a visible image that is displayed on the C-arm monitor. The doctor
can identify and check anatomical details on the image such as blood vessels,
bones, kidney stones and the position of implants and instruments at any time.
The C- arm can be moved and adjusted to different settings based on the
procedure. The C-Arm can also work in conjunction with a table that is designed for
C-Arms. This are used for the general surgery, pain management, aneurysm repair,
catheter placement, cardiac pacemaker implantation, hip replacement,
interventional neuroradiology, neurosurgery, trauma care, lap band surgery, and
needle biopsy.
The first mobile C-arm in the world that uses flat-panel detector technology.
The Ziehm Vision FD features a flat-panel detector based on amorphous silicon (a-
Si) photodiode technology with a field size of 20 cm x 20 cm. The flat-panel detector
provides an unmatched dynamic range with an image quality suitable for a wide
variety of different interventional radiology procedures. The compact design enables
better patient access and increased mobility, so that the unit can easily be brought
to the patient instead of the patient to the unit. The system runs with a pulsing
generator featuring Vision Pulse technology running at a frame rate of up to 30
frames/sec in fluoroscopy mode as well as in DSA or cine loop modes. The user
interface offers an intuitive workflow and logical guidance using two synchronized
TFT touchscreen control panels, one conveniently mounted on a swivel arm of the C-
arm, the other one mounted on the monitor cart.
Cios Select Mobile C-arm and Cios Connect Mobile C-arm (Siemens Healthcare)
Both models are designed for high-quality imaging in surgical applications but
offer slightly different advantages. The Cios Select is geared toward novice
operators with an intuitive button-based user interface and positioning system that
are designed to minimize necessary training. The Cios Connect focuses on
multifunctional usage with an extended free space of 79 cm and immersion depth of
73 cm. Both systems utilize IDEAL (Intelligent Dose Efficiency Algorithm) to provide
a clear view of anatomical details at low dose, with a laser-light localizer on the
image intensifier and tube allowing radiation-free positioning of the C-arm. The
surgeon can fully control the system from one of three touchscreens, one on the C-
arm itself, one on the mobile workstation and one on the tableside control. A sports
vessel overlay software that provides the surgeon with better navigation during
vascular procedures.It was approved by the U.S. Food and Drug Administration
(2014) and was introduced at the Radiological Society of North America (RSNA) in
2015.
The OEC Brivo Prime brings top-notch image quality to mobile C-arms. It has
a Smart AutoTrak that locates and adjusts the image when the anatomy is not
properly centered. It also have an Auto SmartMetal for metal compensation and an
Auto Window feature that increases brightness and illustrates sharp bone
edge. Received U.S. Food and Drug Administration clearance in 2013.
This C-arm system include dynamic range management (DRM) and motion-
tolerant subtraction, which help deliver superior images in various mobile C-arm
imaging situations such as small and dense anatomy. The advanced processing
algorithms provided by DRM and MTS technologies enable real-time elimination of
background information without using a mask image and stepper table. This
patented imaging technique delvers digitally subtracted angiographic runs even
while the patient is moving. This flexibility helps technologists obtain the correct
image quickly with fewer exposures, improving workflow and reducing patients
radiation exposure. The 9900 Elite also offers a motorized option that provides
surgeons and technologists the flexibility to control the C-arm remotely or at the
tableside with a remote user interface and foot pedal. The surgeon has the control
to give direction to the C-arm operator to position the device to the exact, correct
angle in order to have an image that is needed for the procedure. Thus it decreases
the radiation exposure and contract media, saves time because of improved
workflow.
This system marked the switch from image intensifiers to digital detectors.
Several navigational aids were incorporated into the system, including the
ClearGuide function that correlates directions in the image (up/down/left/right) with
physical markers on the detector (3/6/9/12). Operators can use a marker pen with
the outline tool to create free format drawings on live fluoroscopy images, including
vessel outlines and other anatomical references.
Radiation may also cause genetic problem that can directly damages the
reproductive organs, and therefore affects any offspring that individual may have
after the damage has occurred. Damage is done to genes and chromosomes, which
can be passed on to future generations. Studies of survivors of the Hiroshima and
Nagasaki bombings and of the Chernobyl survivors in Ukraine have shown that
there are increased rates of stillbirths, miscarriages, and infant deaths. If the
children survive past the first few years of life, they tend to develop leukemia or
microcephaly (slower cranial development), have birth defects (limbs missing, large
growths), or mental impairments. If exposure to radiation was not acute, then
genetic effects may be minor or may not appear at all. However, Health Canada
acknowledges that exposure to even minute doses of radiation from medical
procedures such as x-rays, fluoroscopy or CT scans can have repercussions on the
unborn fetus and therefore it is recommended that no procedures involving ionizing
radiation be performed during pregnancy.
RATIONALE
MERITS
Fluoroscopy can use in a wide variety of examinations and procedures. These can
be a non-invasive and painlessly which can help to diagnose disease and a support
for medical and surgical treatment planning.
Easily portable, image accessible at multiple locations at the same time, images can
be transmitted over long distances without being distorted and better image quality.
It enabled surgeons to become technically more proficient leading to decreasing
invasiveness, decreased operative time and less morbidity.
In the operating room it guides the surgical team as they insert catheters, stents, or
other devices inside the body.
DEMERITS
The C arm fluoroscopy emits radiation which can cause illness such as skin damage
and the underlying tissues, leukemia, poor digestion and absorption of nutrients
which may occur later in life because of bone marrow irritation and radiation
induce cancer.
Having the knowledge about the motion of c- arm will prepare the nurses in
facing the newly trends in nursing profession in how this equipment / devices being
used by the health team professionals. Recognizing the importance and danger or
treat of one of the latest trends in medical fields can warrant the health team and
can avoid the risk factors. Each one of us, nurses, can have the opportunity to be
educated and know how to handle this type of machines to become more efficient
with the skills we have been doing. Knowledge, skills and attitude are the keys
towards a more effective health team practitioner.
Being skillful in the field we are doing is an asset to become a good health care
provider. To be trained to handle a more advance equipment is an edge and can be
a one step higher. So, we must not stop learning as we go on everyday in our
practice since learning can lead us to a brighter future not only in our profession but
as well as for our self improvement.
Radiology, A. C. (2012, March 20). ACR Practice guideline for imaging pregnant or
potentially pregnant adolescents and women with ionizing radiation.
Retrieved from ACR:
http://www.arc.org/SecondaryMainCategories/quality_safety/guidelines/dxPreg
nancy.aspx
He, J., & al, e. (2016, March 1). Comparison of Isocentric C-Arm 3-D Navigation and
Conventional Fluoroscopy for Percutaneous Retrograde Screwing for Anterior
Column Fracture of Acetabulum: An Observatory Study. Retrieved from
Science Direct:
http://www.sciencedirect.com/science/article/pii/S1529943004009076
Administration, F. a. (2012, March 8). Performance Standard for ionizing Radiation
Emitting Products, Diagnostic X-Ray Systems and their Major Components.
Retrieved from FDA: http://www.accessdata.fda.gov/scripts/cdrh/ cfdocs/ cfcfr/
CFRSearch. cfm
Hsu, R., Lareau, C., & al., e. (2014, August 6). The Effect of C-Arm Position on
Radiation Exposure During FIxation of Pediatric Supracondylar Fractures of
the Humerus. Retrieved from DOI Org: http://dx.doi.org/10.2106/JBJS.M.01076
Ruan, Z., Lou, C., Zeng, B., & et.al. (2013, November 11). Percutaneous Screw
Fixation for the Acetabular Fracture with Quadrilateral Plate involved by
Three DImensional Flouroscopy Navigation: Surgical Technique. Retrieved
from The Journal of Bone and Joint Surgery: http://jbjs.org/content/97/9/721?
trendmd-shared=0
Machita, F., & et.al. (2014, February 4). CT Angiographyafter 20 Years: A
Transformation in Cardiovascular Disease Characterization Continues to
Advance. Retrieved from Blue Sky Ex: http://www.blueskyex.com/index.php?
action=searchsell&cattype=imaging&desc=C-Arm&type=1#
Sean, B., Raymond, T., & et.al. (2013, July 17). Bone Joint Surgery AM. Retrieved
from DOI Org: http://dx.doi.org/10.2016/JBJS.L.00893
Appendices
Appendix C. The Mini C-arm Adds Quality and Efficiency to the Pediatric Orthopedic
Outpatient Clinic.