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Radiation Exposure and Hand Dominance using Mini C-arm Fluoroscopy in Hand Surgery
Corey B. Fuller, MD; Montri D. Wongworawat, MD; Barth Riedel, MD
Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA

Introduction: The mini C-arm is popular with hand surgeons for its portability and decreased radiation generation compared to large C-arms. There has been recent evidence that suggests the mini c-arm is still capable of generating considerable radiation exposure. Hand surgeons are particularly at risk for radiation exposure, as they cannot easily distance themselves from the radiation beam, frequently maintaining fracture reductions with their hands. Previous studies have looked at hand exposure in the dominant hand with mini C-arm. However we have noted the non-dominant hand to is used to maintain reduction placing it closer to the radiation beam.

Materials & Methods: Prospectively, two fellowship-trained hand surgeons wore ring dosimeters on both hands during surgeries involving bony work of the forearm and hand, involving mini C-arm fluoroscopy. The type of case, fluoroscopy time and fluoroscopy radiation output for each case were recorded as well as total radiation exposure to the hands measured from ring dosimeters. Given the ring's threshold in recording radiation of 30 mrem, at least 8 cases per ring was determined to be necessary to achieve measurable data.

Results: 4-ring dosimeters pairs (8 rings total) were worn during 8 cases each (32 cases total) and a second set of 2-ring dosimeters pairs (4 rings total) were worn during 16 cases each (32 cases total). This represents 6-ring dosimeter pairs worn during 64 cases, averaging 10.7 cases per ring. No ring met the minimal dose threshold of 30 mrem to record a numerical value. Each ring experienced an average of 413 seconds of fluoroscopy time and 66.3509 cGy*cm2 of radiation output from the mini C-arm. See table for a breakdown of surgery type and location.

Case Characteristics

Conclusions: Assuming worst-case scenario: each ring measured 29 mrem (just below the threshold), the surgeon's hands experienced 2.7 mrem per case. This would allow a hand surgeon to perform 18,391 cases per year before exceeding the allowable annual hand exposure limit of 50,000 mrem set by the National Council of Radiation Protection (NCRP) & International Commission of Radiological Protection (ICRP). The results do not allow comparison of radiation exposure related to hand dominance.

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