title: Radiation exposure to the hands of orthopaedic surgeons: are we underestimating the risk?
abstract: BACKGROUND
  Previous studies reported that the radiation exposure to the hands of orthopaedic surgeons was far below the acceptable limit. However, the risk could have been underestimated as some factors were overlooked, namely monitoring trainees during average workload, placing dosimeters over the most susceptible locations, measuring the cumulative dosage of radiation and considering the dose limit for non-classified workers.
  
  
  METHODS
  We performed a prospective study in two centres to estimate the radiation dose to the hands of two consultant trauma surgeons and two trainees (one assisting and one operating) while performing 47 fluoroscopy-assisted procedures. We used validated thermoluminescent dosimeters (TLDs) rings and fingerstalls for monitoring the cumulative dosage.
  
  
  RESULTS
  Trainees were at higher risk while performing intramedullary nailing and during assistance. Higher radiation doses were recorded from dominant index fingers and particularly fingertips.
  
  
  CONCLUSIONS
  The risk of radiation exposure appears to be higher than previously reported. Fingertips are more susceptible to radiation exposure and should therefore be monitored in forthcoming studies.
authors.affiliation: St. James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK. mhafez@msn.com
authors.forename: M A
authors.initials: MA
authors.lastname: Hafez
authors.forename: R M
authors.initials: RM
authors.lastname: Smith
authors.forename: S J
authors.initials: SJ
authors.lastname: Matthews
authors.forename: G
authors.initials: G
authors.lastname: Kalap
authors.forename: K P
authors.initials: KP
authors.lastname: Sherman
mesh_terms: D005471:Fluoroscopy / Q000009:adverse effects*; D006225:Hand; D006801:Humans; D016273:Occupational Exposure / Q000009:adverse effects*; D019637:Orthopedic Procedures / Q000009:adverse effects*; D009985:Orthopedics; D011446:Prospective Studies; D011829:Radiation Dosage; D011834:Radiation Monitoring