Paediatric C –arm utility evaluation

Conrad Lee (CT2)

Ms Alex Smith (Consultant Orthopaedic Surgeon)

Guy Cooper (Superintendent Radiographer)

• A large number of paediatric orthopaedic procedures require the use of intraoperative radiography

• large C-arm intensifier are operated by radiographers – Require dedicated radiographer in theatre – Staffing reduced after 5 pm, and at weekends– May be associated with delays in some cases– have been reported to scatter more radiation than mini-C-

arm intensifiers 1, 2

• Mini C-arm can be operated by surgeons– May reduce the need for dedicated radiographer in theatre

Background

• We believe many cases can be done with mini C-arm rather than conventional large C-arm image intensifier

• Having a mini C-arm image-intensifier in the paediatric theatres may – improve the efficiency of operative cases

– save costs / time related to radiographer requirement

Background

• How many paediatric cases are suitable for mini C-arm imaging rather than convectional C-arm operated by radiographers?

• How much time is spent by radiographers in theatres cases needing intraoperative imaging?

• What are the cost implications of requiring radiographers in theatre?

Aims

• Retrospective analysis

• All paediatric cases requiring intraoperative II from June to October 2013 (18 weeks)

• Data collected– Type of procedure – Body part x-rayed intraoperatively – the number of procedures performed out of hours

• Cost analysis

• Estimation time for each type of procedure

Methods

Assumptions Est minsscreening only / injection 10MUA only 15MUA + k-wire toe 15MUA + K-wire finger 20MUA + k-wire wrist 30MUA + k-wire supracondylar humeral fracture 45ORIF wrist 45ORIF ankle / forearm 60IM nail forearm 60

167 paed cases requiring

intraoperative II

161 cases analysed

6 cases excluded due to incorrect

clerical data

81% (n =130)

19%(n=31)

Suitability for mini-C-arm

suitable

not suitalbe

Results

Most x-rayed region

1

2

2

3

4

4

8

10

10

11

14

28

64

0 20 40 60 80

clavicle

abdo

knee

finger

femur

foot

ankle

chest

lower leg

hip

elbow

forearm

wrist

Wrists 40%

Forearm 17%

24.8 hrs

103.8 hrs no

yes

Total radiographer time in theatre in 18 weeks – 128.6 hours (5.3 days)

80.7% (n=130) were deemed suitable for mini C-arm, accounting for a total of 103.8 hours of radiographer time

Suitability

Time / Cost analysis

24.8 hrs

79.2 hrs

24.6 hrs

no

yes

out of hours

24% (24.6 hours) of which were done out of hours. (i.e. higher cost per radiographer time)

The cost for radiographer time spent in theatre is~£6,059.68 per

annum.

Suitability

Time / Cost analysis

• Only crude analysis based on minimum radiographer time saved

• Difficulties recruiting the necessary quota of radiographers

• Funding obtained for half of the mini-C-arm, the remaining half will be given in the next financial year (machine bought)

• re-audit this summer

Discussion and Outcome

• A large percentage of paediatric cases are suitable for screening using mini-C arm rather than conventional large image intensifier

• Acquisition of the mini-C arm can facilitate theatre productivity and reduce demands on the radiology department.

Conclusion

1. Effect of introduction of mini C-arm image intensifier in orthopaedic theatre.White, S P (2007)Annals of the Royal College of Surgeons of England vol. 89 (3) p. 268-71

2. A comparative study of radiation dose and screening time between mini C-arm and standard fluoroscopy in elective foot and ankle surgery.Dawe, Edward J C; Fawzy, Ernest; Kaczynski, Jakub; Hassman, Phillip; Palmer, Simon H (2011)Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons vol. 17 (1) p. 33-6

References