title: Radiation risk from fluoroscopically-assisted anterior cruciate ligament reconstruction.
abstract: BACKGROUND
  Precise tunnel positioning is crucial for success in anterior cruciate ligament (ACL) reconstruction. The use of intra-operative fluoroscopy has been shown to improve the accuracy of tunnel placement. Although radiation exposure is a concern, we lack information on the radiation risk to patients undergoing fluoroscopically-assisted ACL reconstruction with a standard C-arm. The aim of our study was to determine the mean radiation doses received by our patients.
  
  
  METHODS
  Radiation doses were recorded for 18 months between 1 April 2007 and 30 September 2008 for 58 consecutive patients undergoing ACL reconstruction assisted by intra-operative fluoroscopy. Dose area product (DAP) values were used to calculate the entrance skin dose (ESD), an indicator of potential skin damage and the effective dose (ED), an indicator of long-term cancer risk, for each patient.
  
  
  RESULTS
  The median age of 58 patients included in data analysis was 28 years (range, 14-52 years), of whom 44 were male (76%). The mean ESD during intra-operative fluoroscopy was 0.0015 +/- 0.0029 Gy. The mean ED was 0.001 +/- 0.002 mSv. No results exceeded the threshold of 2 Gy for skin damage, and the life-time risk of developing new cancer due to intra-operative fluoroscopy is less than 0.0001%.
  
  
  CONCLUSIONS
  Radiation doses administered during fluoroscopically-assisted ACL reconstruction were safe and do not represent a contra-indication to the procedure.
authors.affiliation: Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK. j.chitnavis@uk-consultants.co.uk
authors.forename: J P
authors.initials: JP
authors.lastname: Chitnavis
authors.forename: A
authors.initials: A
authors.lastname: Karthikesalingam
authors.forename: A
authors.initials: A
authors.lastname: Karthikesaligam
authors.forename: A
authors.initials: A
authors.lastname: Macdonald
authors.forename: C
authors.initials: C
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007430:Intraoperative Care / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology*; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D012867:Skin / Q000528:radiation effects; D055815:Young Adult