gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Patient radiation exposure in fluoroscopically guided injections

Meeting Abstract

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  • presenting/speaker Michelle Spiteri - Nuffield Orthopaedic Centre, Oxford, United Kingdom
  • Sean McGurk - Churchill Hospital, Oxford, United Kingdom

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1385

doi: 10.3205/19ifssh0615, urn:nbn:de:0183-19ifssh06153

Published: February 6, 2020

© 2020 Spiteri et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives/Interrogation: The increased awareness of radiation exposure in the general population has led to patients enquiring about radiation risk following treatment for fracture fixation or guided injections. This study evaluates patient radiation exposure following the use of a Mini C-arm for guided joint injections in the hand and wrist.

Methods: The records of all patients who underwent injections during a four month period in a dedicated clinic were reviewed to assess the total dose area product (DAP) and screening time for the various sites injected. The patient effective dose was then estimated using a DAP to effective dose conversion factor of 0.01mSv/Gycm2 for extremity x-rays.

Results and Conclusions: 138 injections were performed during this time. The majority, 49%, were for first carpometacarpal joint osteoarthritis. Other injection sites were the scaphotrapeziotrapezoid, radiocarpal, distal radio-ulnar and pisotriquetral joints, in addition to various metacarpophalangeal and interphalangeal joints. Patients underwent injections at single (78%), bilateral (12%) and multiple sites (10%). The estimated mean effective dose was 0.08µSv for a single injection site; 0.18µSv for bilateral sites; and 0.11µSv for multiple injections. The most commonly performed injection into a unilateral first carpometacarpal joint had an estimated mean effective does of 0.08µSv. In order to appreciate these values with regard to cancer risk, 0.35µSv results in a 1 in 50,000,000 risk of developing cancer later in life, therefore the above doses provide negligible risk. In the country where this study was performed, the natural background radiation dose is 6.6µSv per day, hence exposure from any of the above injection procedures does not exceed more than approximately one hour of natural background radiation.

Radiation exposure risk should always be taken into consideration when planning patient management. This study shows that patients can be reassured that the risk of fluoroscopically guided injections in the hand and wrist using a Mini C-arm is negligible.