title: Mini C-arm: faster, cheaper, safer?
abstract: BACKGROUND
  Mini C-arm image intensifiers (IIs) are promoted to permit lower radiation dose than traditional IIs with a lower purchase price and without the need for a radiographer, saving time. In real-world usage, radiation dose is not always lower.
  
  
  METHODS
  A retrospective review of prospectively collected data for 620 children undergoing forearm fracture reduction in theatre was undertaken. Imaging was performed with the Fluoroscan mini C-arm or a comparison traditional II. Radiation dose and theatre time were recorded.
  
  
  RESULTS
  There was no significant difference in radiation dose as measured by dose-area product (0.013 versus 0.014 Gy.cm2, P = 0.22). We noted an inverse association between operator experience and radiation dose. The mini C-arm allowed a shorter procedure time (26 versus 30 min, P < 0.001) and theatre time (13 versus 16 min, P < 0.001). Re-displacement rates were similar (1.3 versus 2.2%). The Fluoroscan is AU$120 000 cheaper to purchase and AU$35 283 cheaper to run per year than the comparison II. Consultants had a 14% lower dose-area product (0.012 versus 0.014 Gy.cm2, P < 0.001) and 18% shorter screening time (8 versus 9.8 s, P < 0.001) than registrars.
  
  
  CONCLUSIONS
  The Fluoroscan mini C-arm II does not demonstrate a radiation saving during closed reductions of paediatric forearm fractures but allows shorter procedures and theatre time with similar re-displacement rates. The purchase price is lower than a traditional II. We noted that operator experience reduces radiation dose.
authors.affiliation: Discipline of Orthopaedics and Trauma, The University of Adelaide, Adelaide, South Australia, Australia.|Department of Orthopaedic Surgery, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
authors.forename: Tom J
authors.initials: TJ
authors.lastname: Gieroba
authors.affiliation: Department of Orthopaedic Surgery, Women's and Children's Hospital, North Adelaide, South Australia, Australia.|Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Williams
authors.affiliation: Department of Orthopaedic Surgery, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
authors.forename: Georgia
authors.initials: G
authors.lastname: Antoniou
authors.affiliation: Discipline of Orthopaedics and Trauma, The University of Adelaide, Adelaide, South Australia, Australia.|Department of Orthopaedic Surgery, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Cundy
mesh_terms: D001315:Australia; D002648:Child; D005260:Female; D005471:Fluoroscopy / Q000191:economics / Q000295:instrumentation* / Q000379:methods; D005543:Forearm Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D005592:Fracture Fixation / Q000379:methods; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000295:instrumentation / Q000379:methods; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000032:analysis*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: bone; cast; fluoroscopy; forearm injury; fracture; manipulation; orthopaedic; surgical