Radiation Emission and Protection Regarding the Mobile C-arm in Operating Rooms of the Reinier de Graaf Hospital

Radiation Emission and Protection Regarding the Mobile C-arm in Operating Rooms of the Reinier de Graaf Hospital

Mulder, Marieke (TU Delft Mechanical, Maritime and Materials Engineering)

van den Dobbelsteen, J.J. (mentor)

Delft University of Technology

2020-06-12

The goal of this study was to investigate whether mobile C-arms are being optimally used, securing the safety of staff members in operating rooms of the Reinier de Graaf hospital (RDGG). Mobile C-arm use is evaluated in terms of radiation emission and radiation exposure, staff communication and procedural aspects. The current use of the mobile C-arms was evaluated based on radiation emission data obtained from the X-ray devices and systematic observations in the operating room. From the X-ray devices, the number of exposures, fluoroscopy time, Dose Area Product (DAP) and Air Kerma (AK) values were obtained for trauma, orthopedic and vascular procedures that took place in 2019 and 2020 (until 16-3-2020). These values were visualized and the correlation between the variables was investigated. Observations took place in the operating rooms of the RDGG to evaluate staff actions, staff communication, C-arm utilization and time courses. Finally, the results from previously performed experiments into staff exposure have been evaluated. For these experiments, DoseAware badges were used to measure the dose received by staff members real time during Endovascular Aneurysm Repair (EVAR). Radiation emission data of trauma procedures showed high variability and relatively low patient dose compared to vascular surgery. A positive correlation was found between the number of exposures, fluoroscopy time, DAP and AK. The strongest correlation was found between DAP and AK. During observations, the staff has indicated to be aware of how to keep radiation exposure as low as reasonably possible, however in practice, few actions are being undertaken to minimize the dose. Also, communication between surgeon and C-arm controller and the experience of the C-arm controller and surgeon seem to have significant influence on the radiation use and operating time. Mainly lack of experience of the C-arm controller has shown to affect the number of exposures and process flow. The heavy and large design of the C-arm also complicates communication and positioning. Finally, DoseAware experiments showed that during EVAR procedures, the anesthesiologist and C-arm controller receive a significant dose which can be avoided. From available data, it can be concluded that the C-arm is currently not optimally used in the Reinier de Graaf hospital. The dose received by staff members is higher than necessary in order to provide good patient care. Differences in dose received for different types of surgery that make use of the same fluoroscopy time can be appointed to the size of body parts that are operated and the use of metal. In order to optimize the use of the mobile C-arm, the number of exposures can be decreased by education of C-arm controllers and communication improvement. A redesign of the C-arm could make communicating and positioning of the C-arm easier. Also, staff awareness should lead to actions in limiting exposure by shielding and taking distance. Finally, the current system concerning C-arm controller allocation to procedures should be revised. In order to enable future improvements, radiation and procedural data should be stored more specifically and continuously.

Mobile C-arm
Operating room
Staff safety
Radiation exposure

http://resolver.tudelft.nl/uuid:0d87e8ca-7b93-449b-8146-cb6ea0431fbf

2021-06-12

Student theses

master thesis

© 2020 Marieke Mulder