Magnification assessment of radiographs for knee replacement (MARKeR) - A pilot study in a low-resource setting.

Background: Selecting the correct size of implants to be used in total knee arthroplasty is critical for a successful outcome. Marker-less templating systems use an institutionally derived magnification factor for all radiographs. Purpose: To determine the institutional magnification of knee radiographs for patients awaiting total knee arthroplasty. Material and Methods: Eighty patients awaiting total knee arthroplasty underwent preoperative knee radiographs using a standardized protocol. A marker attached to the patients' knees at the level of the knee joint was used to calculate the magnification factor on both anteroposterior (AP) and lateral (LAT) views. Two independent observers estimated the magnification to determine the intra and inter-observer reliability. Results: The mean magnification of the AP (15.3%) radiograph was significantly greater than the LAT (12.1%) radiograph (p< 0.0001). Patients with absent markers on their radiographs were heavier than patients in whom the marker was visible (84.7 kgs vs. 76.6 kgs, p=0.01). No marker was visible on the radiographs in 56.3% (45/80) of patients. There was excellent inter and intra-observer reliability of both the AP and LAT measurements. Conclusion: After standardizing the protocol for preoperative knee radiographs, our results show significantly greater institutional magnification of the anteroposterior compared with the lateral images. Accurate templating in knee arthroplasty requires both radiographic images. To reduce errors in implant sizing, we recommend surgeons use different institutional magnification factors for the anteroposterior and lateral radiographs.

Operation notes in orthopaedics: Beliefs and practices in a developing country.

Maintaining accurate and complete operation notes is an essential metric of the quality of surgical care. While developed countries have implemented electronic health records to improve documentation, financial constraints prevent this realisation in the Caribbean. Somewhat paradoxically, previous studies in this area have focussed on 'process' while neglecting the key role of the surgeon. We conducted a 25-item Knowledge, Attitudes and Practices survey of orthopaedic doctors to identify any culturally unique health-related behaviours. Our results indicate that while most doctors understand the importance of operation notes, many are unaware of international note-keeping recommendations. Legibility was identified as a significant issue by 92% of doctors. A disturbing and previously unreported finding from the study revealed that 72% of surgeons would occasionally write the operation notes, although they were not scrubbed in for the procedure. We suggest that future studies examine this peculiar behaviour in greater detail.

Knowledge and practice of radiation safety among health professionals in Trinidad.

OBJECTIVE: To determine the practices and knowledge of radiation safety measures among health care providers in tertiary institutions in Trinidad. DESIGN & METHOD: A cross-sectional survey of health care professionals within two public hospitals was conducted using a questionnaire distributed to individuals working in Cardiology, General Surgery, Internal medicine, Orthopaedics, Radiology and Urology who require the use of ionizing radiation machines. The questionnaire comprised of 30 questions divided into five subcategories including demographic data, usage of the ionizing radiation machines, basic knowledge, and attitude towards personal protective equipment as well as radiation exposure measurement. Questionnaire results were tabulated and analysed using Microsoft Excel and Stata v11 with comparative statistical analysis being done using the one-way analysis of variance test. RESULTS: A total of 118 health care professionals participated in this study. The majority (85/118 (72%)) of individuals revealed that they had no formal training regarding safe practices when working with ionizing radiation despite the daily use of the fluoroscopy machines by at least 25% of participants. Individuals who had formal training in the use of ionizing radiation were found to score significantly higher than those without training (p < 0.0001). Participants' knowledge regarding the proper positioning of the C-arm image intensifier to reduce radiation exposure was low with 46% of individuals providing a correct response. CONCLUSIONS: The level of knowledge among the individuals who participate in the operation of ionizing radiation equipment throughout the country is low. The benefit of training in the use of the C-arm image intensifier is highlighted by the revelation that the individuals who had formal training in the use of these machines performed better than those individuals without training. Annual recertification courses should be implemented such that individuals are kept abreast with current changes and reminded of commonly neglected safety practices.