Paediatric c –arm utility evaluation
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Transcript of Paediatric c –arm utility evaluation
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