By staff writers

August 8, 2018 -- A multicenter survey in France has resulted in proposed diagnostic reference levels (DRLs) for fluoroscopy performed during eight types of surgical procedures. The researchers shared their results in an article published online on 1 August in European Radiology.

Setting out to assess DRLs in surgery for the most frequent procedures, as required by the European Directive 2013/59/Euratom, researchers led by Joel Greffier of Nimes University Hospital in France retrospectively conducted a survey in six French facilities to analyze eight orthopedic, urology, and gastrointestinal surgical procedures. For each center, they recorded kerma area product (KAP) and fluoroscopy time for 30 patients who received elbow surgery and 50 patients who underwent the other seven surgical procedures during a period from September 2016 to September 2017. DRLs were calculated as the third quartiles of the distributions.

The researchers observed the delivered dose in surgery depends on the procedure, practice, and patient. They also proposed DRLs for the eight surgical procedures.

Proposed DRLs by surgical procedure
  Hand/wrist (conventional C-arm/mini C-arm) Elbow Shoulder (intramedullary/
Hip (proximal femoral intramedullary nail) Foot/ankle (conventional C-arm/mini C-arm) Implantable venous access port insertion Laparoscopic cholecystectomy Double-J ureteral catheter insertion
KAP (mGy cm2) 125/30 185 1,500/420 2,130 250/55 345 1,185 2,195
Fluoroscopy time (min) 0.6/0.4 0.7 2.4/0.8 1.4 0.6/0.5 0.5 0.9 1.0

"The results of this study may serve as an input for the national radiation protection authorities to implement DRLs in surgery as required by the 2017 [International Commission on Radiological Protection] publication," the authors wrote. "These results will allow surgery departments to benchmark their practice with others and to optimize their protocols if necessary."

Copyright © 2018

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