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Flouroscopic Radiation to the Surgeons' Hands: What's Our Exposure?
Michael Vosbikian, MD1; Ronald Huang, MD1; Asif M. Ilyas, MD1; Charles Leinberry, MD2
1Thomas Jefferson University, Philadelphia, PA; 2Rothman Institute, Philadelphia, PA

Background: The use of fluoroscopy is common place in the practice of orthopaedic surgery, and it can be achieved with either the use of a standard or mini C-arm. Controversy exists as to which device is safer for the surgeon. Furthermore, little is known about the radiation exposure to the surgeon's hands, which is in closest proximity to the fluoroscope and most vulnerable to radiation exposure. The primary goal of this study was to examine the difference in exposure to the hands of the surgeon between the use of the standard C-arm versus mini C-arm units in a hand surgeons' practice.
Methods: Two surgeons wore ring dosimeters on their non-dominant ring fingers during consecutive operative cases. One surgeon used a standard large C-arm, while the other used mini C-arm fluoroscopy. The data collected included type of case, fluoroscopy time, radiation emitted, fluoroscopy time per case, dose per case, and dose by time. Exposure data from the dosimeters was also analyzed.
Results: An analysis was performed on 71 cases, with 36 cases in the mini C-arm group and 25 cases in the standard C-arm group. It was found that the mean dose per case for the mini C-arm was 27.02 mGy versus the standard C-arm was 0.95 mGy (p<0.001). There was a significant difference in fluoroscopy time per case with the mini C-arm of 118.44 seconds, versus the standard C-arm of 49.56 seconds (p<0.001). There was also a difference with respect to dose over time with the mini C-arm emitting 0.24 mGy/sec versus standard C-arm 0.02 mGy/sec (p<0.001). The ring dosimeter exposure revealed that the mini C-arm accumulated a cumulative exposure of 800 mrem, versus 300 mrem for the standard C-arm. This distills down to an average exposure of 0.24 mrem per second for the mini C-arm and 0.19 mrem per second for the standard C-arm.
Conclusions: Our analysis shows that use of the mini C-arm is associated with approximately a 10 times higher total radiation dose than the standard C-arm. Moreover, ring dosimeter measurements noted an almost 3 times greater absorption of radiation with the mini C-arm compared to the standard C-arm. This increased exposure is more than can be accounted for by the fluoroscopy time difference between cases. Though both groups' radiation exposure totals are below recommended maximums, due to the non-trivial radiation exposure found, we recommend routinely using techniques to minimize intraoperative radiation exposure to the surgeons' hands.


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