Year: 2025
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: Fluoroscopy is widely used in paediatric orthopaedic surgery; however, national diagnostic reference levels (DRLs) for intraoperative radiation exposure are lacking. Establishing local DRLs is essential to benchmark practice, optimise patient safety, and inform future national standards. This study quantifies radiation exposure across common paediatric orthopaedic procedures to provide data for local reference ranges. METHODS: A retrospective observational study was performed at a single-centre NHS specialist children's hospital, including 480 procedures in patients aged <18 years over a four-year period. Procedures were categorised by anatomical region (elbow, ankle, pelvis) and type: manipulation under anaesthesia (MUA), MUA with K-wire fixation, and open reduction and internal fixation (ORIF). Fluoroscopy radiation exposure (mGy/cm²) was recorded. Descriptive statistics (25th percentile, median, 75th percentile, mean) were calculated, and differences between procedure types were assessed using Mann-Whitney U tests (p < 0.05). Radiation doses were contextualised against local background exposure and transatlantic flight equivalents. RESULTS: Slipped upper femoral epiphysis (SUFE) pinning had the highest mean exposure (384.5 mGy/cm²). In the elbow subgroup, ORIF had the highest mean exposure (13.9 mGy/cm²), while MUA + K-wire fixation had the highest ankle exposure (12.4 mGy/cm²). MUA + K-wire procedures showed significantly higher exposures than simple MUA in both the elbow (p < 0.001) and ankle (p < 0.001). Pelvic MUA procedures had higher exposure than elbow or ankle MUA (p < 0.001). CONCLUSIONS: This study establishes the first detailed local reference ranges for intra-operative fluoroscopy in paediatric orthopaedics. Findings demonstrate procedure-specific variability in radiation exposure, support the development of local DRLs, and provide a benchmark for safer practice and future national standardisation.
Source: Cureus
DOI: 10.7759/cureus.96053
Authors: Kraig Jamieson, Simon Barker
Institutions: Ninewells Hospital, Royal Aberdeen Children's Hospital
Language: English
Topic: Radiation Dose and Imaging
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4415845337