Materials and Methods
Total fluoroscopy times were recorded
for each central line case performed in
the two months prior to installation of
the laser targeting system. Cases from
all surgeons performing this operation
were included (n = 24). After the laser
targeting device was installed the surgeons were given a short tutorial by the
radiology technologists on the use of
the device. For the next several months,
fluoroscopy times were again recorded
for each central line placed with laser
guidance (n = 25). Fluoroscopy times
were compared as an estimate of relative
Any pediatric patient (under 18
years of age) at CCMC receiving a central line in the operating room with the
assistance of C-arm fluoroscopy was
included in the study. A waiver for consent was obtained by the IRB at CCMC.
No identifiable patient information was
recorded at any time during the study.
In addition, no identifiable information
was recorded about the surgeons performing the procedures.
This was a prospective study. Central
line placement was the procedure chosen for comparison because it is a common procedure and all of the surgeons
performing the procedure use C-arm
fluoroscopy to assist them. All surgeons
at CCMC receive fluoroscopy training, including the importance of dose
reduction, prior to obtaining in hospital fluoroscopy privileges. No additional
training on dose reduction was provided
prior to the study or after installation of
the targeting system.
Fluoroscopy times from all pediatric
surgeons performing central line place-
ments were obtained for two months
prior to installation of the targeting
device (n = 20). The device was installed
and all of the radiology technologists
who accompany the C-arms to the oper-
ating suites were trained in its use. The
surgeons using the C-arms were given
brief instruction on the use of the device
by the radiology technologists prior
to their first time using it. Fluoroscopy
times were again recorded for the 20 sub-
sequent cases after the installation.
A simple mean and standard deviation
was calculated for fluoroscopy times pre
and post placement of the laser targeting system. A one tailed Students test was
used to compare the two groups for statistically significant differences. The data
were initially evaluated using every data
point acquired. Several cases were noted
to have very long fluoroscopy times and
were likely complicated, difficult cases.
These cases with flouro times greater
than 55 seconds significantly increased
the standard deviations for each group,
limiting the ability of the study to assess
for differences in fluoroscopy times.
Because of this, one patient from the
pre laser group was excluded and two
patients from the post laser group were
excluded and the data was reanalyzed.
The data from individual surgeons were
also compared. Due to the low sample
number for each surgeon, this data was
not analyzed for statistical significance.
Fluoroscopy times were reduced, on
average, 17% when using the C-arm
with laser targeting compared to the
C-arm without laser targeting (p = . 36).
The data were reanalyzed after removing three difficult cases from the dataset,
defined as cases using longer than 55 seconds of fluoroscopy time. With difficult
cases removed, fluoroscopy times were
reduced from 17. 4 to 12. 9 seconds, on
average, in the laser targeting group. This
represents a P value of . 12 which is not
of statistical significance. See Figures 1–4.
There is a trend towards fluoroscopy
times being lower when a laser targeting
system is used. Although these findings
do not reach statistical significance, the
trend towards reduction in radiation
dose is interesting. When the data are
separated out for the individual surgeons,
Mean fluoro times separated by surgeon
Figure 1 • Mean fluoro times separated by surgeon
There is a trend towards fluoroscopy times being lower
when a laser targeting system is used.
Laser Targeting with C-arm Fluoroscopy: Effect on Radiation Exposure for Pediatric Patients