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Hand and Body Radiation Exposure With the Use of Mini C-Arm Fluoroscopy

  • Christopher J. Tuohy
    Affiliations
    Department of Orthopedic Surgery, Wake Forest University, Winston-Salem, NC; Vanderbilt Orthopaedic Institute, Hand and Upper Extremity Center, Nashville, TN
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  • Douglas R. Weikert
    Affiliations
    Department of Orthopedic Surgery, Wake Forest University, Winston-Salem, NC; Vanderbilt Orthopaedic Institute, Hand and Upper Extremity Center, Nashville, TN
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  • Jeffry T. Watson
    Affiliations
    Department of Orthopedic Surgery, Wake Forest University, Winston-Salem, NC; Vanderbilt Orthopaedic Institute, Hand and Upper Extremity Center, Nashville, TN
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  • Donald H. Lee
    Correspondence
    Corresponding author: Donald H. Lee, MD, Vanderbilt Orthopaedic Institute, Hand and Upper Extremity Center, Medical Center East, South Tower, Suite 3200, Nashville, TN 37232-8828
    Affiliations
    Department of Orthopedic Surgery, Wake Forest University, Winston-Salem, NC; Vanderbilt Orthopaedic Institute, Hand and Upper Extremity Center, Nashville, TN
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Published:February 24, 2011DOI:https://doi.org/10.1016/j.jhsa.2010.12.022

      Purpose

      To determine whole body and hand radiation exposure to the hand surgeon wearing a lead apron during routine intraoperative use of the mini C-arm fluoroscope.

      Methods

      Four surgeons (3 hand attending surgeons and 1 hand fellow) monitored their radiation exposure for a total of 200 consecutive cases (50 cases per surgeon) requiring mini C-arm fluoroscopy. Each surgeon measured radiation exposure with a badge dosimeter placed on the outside breast pocket of the lead apron (external whole body exposure), a second badge dosimeter under the lead apron (shielded whole body exposure), and a ring dosimeter (hand exposure).

      Results

      Completed records were noted in 198 cases, with an average fluoroscopy time of 133.52 seconds and average cumulative dose of 19,260 rem-cm2 per case. The total measured radiation exposures for the (1) external whole body exposure dosimeters were 16 mrem (for shallow depth), 7 mrem (for eye depth), and less than 1 mrem (for deep depth); (2) shielded whole body badge dosimeters recorded less than 1 mrem; and (3) ring dosimeters totaled 170 mrem. The total radial exposure for 4 ring dosimeters that had registered a threshold of 30 mrem or more of radiation exposure was 170 mrem at the skin level, for an average of 42.5 mrem per dosimeter ring or 6.3 mrem per case.

      Conclusions

      This study of whole body and hand radiation exposure from the mini C-arm includes the largest number of surgical cases in the published literature. The measured whole body and hand radiation exposure received by the hand surgeon from the mini C-arm represents a minimal risk of radiation, based on the current National Council on Radiation Protection and Management standards of annual dose limits (5,000 mrem per year for whole body and 50,000 mrem per year to the extremities).

      Key words

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