C-arm x-ray machines are a standard imaging technology in many outpatient surgery facilities. These imaging units are commonly used for orthopedic procedures, pain management, and emergency medicine.
Being quite common and used in several types of procedures, healthcare professionals are often exposed to their radiation. However, due to the lack of knowledge, risk perception, or radiation protection strategies, healthcare professionals tend to be casual about it.
The truth is that exposure to c-arm x-ray radiation might lead to cancer and other side effects and health complications.
In this guide, we will explore basic concepts regarding c-arm – such as what are c-arm x-ray machines – while still touch topics such as:
- How does the c-arm work?
- How doctors can protect themselves from c-arm radiation
- Making the most out of the technology and preparing for the future
What is a c-arm x-ray machine and how does it work?
A c-arm machine is an imaging scanner intensifier. C-arms have radiographic capabilities and are used primarily for intraoperative imaging during surgical, orthopedic, and emergency care procedures. The c-arm is often also known as a portable x-ray and is used for fluoroscopy.
Fluoroscopy procedures are medical techniques that allow images to be captured inside parts of the body in real-time.
The generator emits x-rays that penetrate the patient’s body. The image intensifier or detector converts the x-rays into a visible image displayed on the c-arm monitor.
The c-shaped connecting element allows movement horizontally, vertically, and around the swivel axes, so that x-ray images of the patient are produced from almost any angle.
Thus, some of the radiation is transmitted to the image intensifier, some are absorbed by the patient and some are emitted as scatter radiation. The latter is a significant exposure to radiation for the healthcare staff in the room, who do several procedures every day.
The x-ray released by the c-arm fluoroscopy does not emit any physical sensation, such as smell or sound. For that matter, healthcare professionals often forget to apply the most correct strategies to protect against radiation.
While full protection is advised, some body parts/organs are more sensible and, thus should have extra protection.
How doctors can protect themselves from c-arm radiation
- Wearing proper radiation protection, such as a lead apron, is essential to protect medical staff from radiation.
- C-Arm machines usually need a 0.5mm lead (or equivalent). This attenuates scattered x-ray beams. Some body parts are more susceptible to radiation. As such, these should be protected.
- To ensure that it is safe, you may use the x-ray image intensifier to try to scan someone who is wearing the equipment. Then you examine the image for cracks or imperfections captured by the c-arm machine. It’s also suggested that the radiation protective shields are not folded when stored, as it breaks the lead protection.
- The intensity of the radiation becomes lower by the distance. Hence, a 2-meter safe zone from the c-arm system is highly recommended, suggests research1.
- The position of the c-arm follows the same principle. The amount of radiation the surgeon is exposed to when the fluoroscopy is performed in a horizontal position is at its max. As such, while position varies depending on the procedure, it is suggested2 that the x-ray source should be directed from the medial to the lateral direction.
- Preparation might also be a key to success. While at some point you will be needing the c-arm before and after the procedure is done, proper preparation for the procedure might reduce radiation exposure.
When preparing a surgery with implants, by correctly anticipating the model, size, and position of the implant, fewer tries are needed to form the procedure. Thus reducing the use of the c-arm and, consequently, radiation exposure. For that matter, digital templating is a huge advantage in making surgeries faster and safer.
Making the best out of c-arm in surgery
Mobile c-arm brings the greatest advantages to surgery, but like every other as it allows it to be moved around the patient. However, if correct measures are not taken care of, it might bring huge disadvantages to the user.
While studies suggest that the total amount of radiation exposure during fluoroscopy is not above the recommended levels, protection is still highly recommended.
It is possible to get cancer from c-arm fluoroscopy.
Many of the healthcare professionals who often are in the OR, like orthopedic surgeons, are not considered radiation workers and often do not get the necessary recommendations. Radiation safety precautions should be considered and safety programs should be routine.
As such, it is important to know and have clear, defined strategies when it comes to technology — should it be orthopedic or not.
1 - Mahajan, A. (2015). Occupational radiation exposure from c arm fluoroscopy during common orthopaedic surgical procedures and its prevention. Journal of Clinical and Diagnostic Research.
2 - Alonso, J. A., Shaw, D. L., Maxwell, A., McGill, G. P., & Hart, G. C. (2001). Scattered radiation during fixation of hip fractures: Is distance alone enough protection?. The Journal of Bone and Joint Surgery.