Archive Staff & Patient Safety 2017

5 Steps to Improved C-Arm Safety

Protect your surgical team from intraoperative imaging's hidden harm.

Richard Yoon, MD


protective equipment DRESS IN LAYERS Proper personal protective equipment is often overlooked and underused.

Radiation's invisible dangers don't make them any less real, but surgical teams continue to jeopardize their long-term health by failing to implement commonsense precautions that reduce their exposure risks. Following these 5 tips will ensure your surgeons and staff have a healthy respect for radiation and shield themselves from scatter whenever C-arms are rolled into the OR.

1 Don't overdo it
ALARA — "as low as reasonably achievable" — must be surgical imaging's guiding principle. Although capturing extra images can provide valuable information during technically demanding procedures, surgeons need to rely on snapshots of anatomy that are only absolutely necessary for performing surgery effectively and safely. Getting surgical images with as little radiation exposure as possible, and magnifying images only when it's clinically necessary, will improve the safety of everyone in the room. There are several ways to adhere to the ALARA principle:

Use fewer shots. Pulsed fluoroscopy captures 1 to 6 images per second and, when clinically appropriate, is preferable to continuous fluoroscopy, which captures 30 images per second.

Have a plan. Mark anatomical landmarks on the patient or on the surgical drapes to let surgeons and radiology techs focus on targeted anatomy with fewer fluoroscopic shots. Using tape to mark where the C-arm should be positioned and repositioned when multiple images are needed can also help limit the shots taken and will shorten case times.

Direct the beam. Collimation involves adjusting the size of the C-arm's aperture to reduce the size of the X-ray beam and focus it on the targeted anatomy. The adjustment limits the radiation dose required to capture images and subsequent radiation scatter.

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