Accuracy of intraoperative fluoroscopy with and without laser guidance in foot and ankle surgery

Background: The use of intraoperative fluoroscopy in orthopedic surgery involves frequent exposure to ionizing radiation in the operating room. Although a number of studies have found radiation exposure to orthopedic surgeons to be well below recommended doses, the long-term effects of low-dose radiation are not well known. Thus, all effective practical methods should be undertaken to reduce the exposure to radiation. Our purpose was to determine whether the use of a laser-aiming device improves the accuracy of intraoperative fluoroscopy to reduce, by implication, radiation exposure in the operating room. Methods: From March to October 2004, there were 92 consecutive cases requiring use of fluoroscopy in the orthopedic foot and ankle service of the authors' institution. The number of accurate and inaccurate images with or without the presence of a radiology technician and a laser-aiming device were compared. Results: The accuracy of imaging with the laser-aiming device was higher than the imaging without the device (p < 0.001). The accuracy of the images obtained by the surgeon was higher than the technicians' images when laser guidance was used (p = 0.027). There was no significant difference between the images obtained by the surgeon or the technicians when the aiming device was not used (p = 0.09). Conclusion: The use of a laser-aiming device to help position during fluoroscopy is recommended in an effort to reduce radiation exposure in foot and ankle surgery.