Hospital diagnostic reference levels for trauma orthopaedic surgical procedures

Abstract

Background:  The aim of study was to establish the hospital diagnostic reference levels 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 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 DAP for each procedure type were calculated as well as median and average value of fluoroscopy screening time. Results: Median and third quartile DAP values for dynamic hip screw fixation were set at 0.52 Gycm² and 1.07 Gycm², respectively; for proximal femoral nail insertion at 0.53 Gycm² and 0.74 Gycm², respectively and for proximal humeral nail insertion at 0.26 Gycm² and 0.41 Gycm², respectively. For implantation of partial endoprosthesis median and third quartile DAP values utilizing flat panel technology were set at 0.08 Gycm² and 0.17 Gycm², respectively and at 0.21 Gycm² and 0.31 Gycm², respectively when the image intensifier technology was used. Median and third quartile DAP values for percutaneous posterior spine fixation were set at 1.26 Gycm² and 1.63 Gycm², respectively, using flat panel technology and at 3.98 Gycm² and 5.53 Gycm², respectively using image intensifier technology. Conclusions: Established diagnostic reference levels of surgical orthopaedic procedures in traumatology will serve as a valuable tool for radiation exposure optimization.