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Radiation dosage is related to changes in lymphocyte count, interleukin-6, and c-reactive protein levels during C-arm use in closed femoral nailing surgery

  • Ketut Kris Adi Marta ,
  • Putu Astawa ,
  • I Ketut Suyasa ,
  • Anak Agung Wiradewi Lestari ,
  • I Gede Eka Wiratnaya ,


Introduction: Although the C-arm allows real-time image capture and intensification to allow accurate placement of implants and fixation devices with minimal incisions, these advantages have the disadvantage of the amount of radiation exposure to operating room personnel, especially surgical operators. The exposure mainly was low dose (<1 Sv). However, the effects of low-dose exposure may be accurate and should be considered seriously.

Methods: This research was an observational prospective cohort study. A total of 30 residents who met the inclusion criteria had blood samples taken before and after femoral nailing surgery. Then, the blood sample underwent a complete blood count, IL-6, and CRP levels examination. During surgery, C-arm radiation will be measured using a personal dosimeter. The statistical tests used were descriptive statistics, proportion comparison analysis with the dependent t-test, and simple linear regression tests.

Results: Univariate analysis using paired t-test proved changes in lymphocyte count, IL-6, and CRP levels of orthopedic residents before and after femoral nailing surgery with c-arm guiding with a statistically significant difference, based on p-values respectively: p=0.001; p=0.001; p=0.002. Simple linear regression test proved that radiation dosage of c-arm during operation is associated with a change in lymphocyte count, IL-6 and CRP levels before and after femoral nailing surgery with R squared values respectively: 0.474 (p=0.001), 0.694 (p=0.001) and 0.701 (p=0.001).

Conclusion: Radiation dosage of c-arm during femoral nailing surgery is related to changes in lymphocyte count, interleukin-6, and c-reactive protein levels among orthopedics and traumatology residents.



  1. El-Shanshoury H, El-Shanshoury G, Abaza A. Evaluation of low dose ionizing radiation effect on some blood components in animal model. J Radiat Res Appl Sci. 2016 Jul;9(3):282–93. Available from:
  2. International Atomic Energy Agency. Effects of ionizing radiation on blood and blood components: A survey. Vienna, Austria; 1997.
  3. Kozlova EK, Sergunova VA, Krasavin EA, Boreyko A V., Zavialova A V., Kozlov AP, et al. Local defects in the nanostructure of the membrane of erythrocytes upon ionizing radiation of blood. Physics of Particles and Nuclei Letters. 2016 Jan 6;13(1):140–8. Available from:
  4. Ahmed A, Fawzy M, Nasr MAR, Hussam AM, Fouad E, Aboeldahb H, et al. Ultrasound-guided quadratus lumborum block for postoperative pain control in patients undergoing unilateral inguinal hernia repair, a comparative study between two approaches. BMC Anesthesiol. 2019 Oct 17;19(1):184. Available from:
  5. Hayashi T, Furukawa K, Morishita Y, Hayashi I, Kato N, Yoshida K, et al. Intracellular reactive oxygen species level in blood cells of atomic bomb survivors is increased due to aging and radiation exposure. Free Radic Biol Med. 2021 Aug;171:126–34. Available from:
  6. Sproston NR, Ashworth JJ. Role of C-Reactive Protein at Sites of Inflammation and Infection. Front Immunol. 2018 Apr 13;9. Available from:
  7. Cheki M, Shirazi A, Mahmoudzadeh A, Bazzaz JT, Hosseinimehr SJ. The radioprotective effect of metformin against cytotoxicity and genotoxicity induced by ionizing radiation in cultured human blood lymphocytes. Mutation Research/Genetic Toxicology and Environmental Mutagenesis. 2016 Oct;809:24–32. Available from:
  8. Ryuji Okazaki. Radiation Protection from the History of Ionizing Radiation. Occup Health Rev. 2023;36(1):1.
  9. Ratini NN, Trisnawati NLP, Sutapa GN. The Quantity and Leukocytes Components as Biological Dosimeters on the Radiation Workers at Radiology Installation RSUP Sanglah Hospital Denpasar. Bali Medical Journal. 2018 Oct 3;7(3). Available from:
  10. Torres Filho IP, Torres LN, Barraza D, Williams CE, Hildreth K. Cellular and Biochemical Effects of Combined X-Ray Radiation and Storage on Whole Blood. Dose-Response. 2022 Jan 29;20(1):155932582110731. Available from:
  11. Lumniczky K, Impens N, Armengol G, Candéias S, Georgakilas AG, Hornhardt S, et al. Low dose ionizing radiation effects on the immune system. Environ Int. 2021 Apr;149:106212. Available from:
  12. Matiello J, Dal Pra A, Zardo L, Silva R, Berton DC. Impacts of post‐radiotherapy lymphocyte count on progression‐free and overall survival in patients with stage III lung cancer. Thorac Cancer. 2020 Nov 21;11(11):3139–44. Available from:
  13. Swanson G, Hammonds K. Long-Term Effects of Radiation on Lymphocytes and Risk of Opportunistic Infections. Cureus. 2022 Jul 15;14(7): e26887. Available from:
  14. BEETZ GMTODVA. Induction of interleukin 6 by ionizing radiation in a human epithelial cell line: control by corticosteroids. Int J Radiat Biol. 1997 Jan 3;72(1):33–43. Available from:
  15. Ahmad IM, Abdalla MY, Moore TA, Bartenhagen L, Case AJ, Zimmerman MC. Healthcare Workers Occupationally Exposed to Ionizing Radiation Exhibit Altered Levels of Inflammatory Cytokines and Redox Parameters. Antioxidants. 2019 Jan 1;8(1):12. Available from:
  16. Nouri F, Babaee M, Peydayesh P, Esmaily H, Raeissadat SA. Comparison between the effects of ultrasound guided intra-articular injections of platelet-rich plasma (PRP), high molecular weight hyaluronic acid, and their combination in hip osteoarthritis: a randomized clinical trial. BMC Musculoskelet Disord. 2022 Sep 12;23(1):856. Available from:
  17. Wygoda A, Mrochem-Kwarciak JJ, Kentnowski M, Rutkowski T, Pilecki B, Heyda A, et al. C-Reactive Protein as a Biomarker of Radiation Therapy and Chemotherapy Toxicity Monitoring in Patients With Head and Neck Cancer. International Journal of Radiation Oncology*Biology*Physics. 2016 Mar;94(4):905. Available from:
  18. Cengiz M, Akbulut S, Atahan IL, Grigsby PW. Acute phase response during radiotherapy. International Journal of Radiation Oncology*Biology*Physics. 2001 Mar;49(4):1093–6. Available from:
  19. Canada JM, Thomas GK, Trankle CR, Carbone S, Billingsley H, Van Tassell BW, et al. Increased C-reactive protein is associated with the severity of thoracic radiotherapy-induced cardiomyopathy. Cardio-Oncology. 2020 Dec 28;6(1):2. Available from:
  20. Yahyapour R, Amini P, Rezapour S, Cheki M, Rezaeyan A, Farhood B, et al. Radiation-induced inflammation and autoimmune diseases. Mil Med Res. 2018 Mar 20;5(1):9. Available from:

How to Cite

Marta, K. K. A., Astawa, P., Suyasa, I. K. ., Lestari, A. A. W. ., & Wiratnaya, I. G. E. . (2024). Radiation dosage is related to changes in lymphocyte count, interleukin-6, and c-reactive protein levels during C-arm use in closed femoral nailing surgery . Indonesia Journal of Biomedical Science, 18(1), 61–66.




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Ketut Kris Adi Marta
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Putu Astawa
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I Ketut Suyasa
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Anak Agung Wiradewi Lestari
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I Gede Eka Wiratnaya
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