• Muntadhir Al-Uzri, Azeem Thahir, Ali Abdulkarim, and Matija Krkovic.
• Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. m.aluzri@doctors.org.uk.
• Arch Orthop Trauma Surg. 2020 Dec 1; 140 (12): 1965-1970.

IntroductionLimb reconstruction using circular frames requires complex accurate measurements to achieve correction of mechanical bone axis. Inadequate imaging could ultimately lead to poor clinical outcome. Therefore, radiographs should be obtained in a standardised manner to yield accurate results. Our aim is to improve the effectiveness of post-operative imaging by obtaining precise examinations and improving the accuracy of frame correction; therefore, reducing technical repeats, radiation exposure, time waste in clinic, and achieving cost effectiveness.MethodsWe implemented a simple technique for obtaining adequate imaging using standard X-ray equipment. This technique was introduced to the radiographers in the radiology department to image patients with circular frames. Images were taken by obtaining a field of view using the X-ray machine cone of light that is orthogonal to the location of interest in both the antero-posterior (AP) and lateral planes. We compared the quality of radiographs, number of repeated X-rays and radiation dose both before and after implementing our protocol RESULTS: We assessed 54 consultations before and 63 consultations after the implementation of our protocol. The results showed a reduction in inadequate radiographs from 78% to 13% department at Addenbrooke's Hospital at a statistical significance of p < 0.00001. In addition, we found a potential radiation dose reduction of 2.7-0.32mSev between the two cohorts. Our results indicate that there would also be a reduction in the cost to the department as well as time spent repeating inaccurate radiographs.ConclusionWe have been able to achieve a significant improvement in the quality of post-operative radiographic imaging and have expanded its use to adult frame patients with a background of traumatic or infectious aetiologies.

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