title: Radiation exposure of eyes, thyroid gland and hands in orthopaedic staff: a systematic review.
abstract: BACKGROUND
  Various procedures, especially minimal invasive techniques using fluoroscopy, pose a risk of radiation exposure to orthopaedic staff. Anatomical sites such as the eyes, thyroid glands and hands are more vulnerable to radiation considering the limited use of personal protective devices in the workplace. The objective of the study is to assess the annual mean cumulative and per procedure radiation dose received at anatomical locations like eyes, thyroid glands and hands in orthopaedic staff using systematic review.
  
  
  METHODS
  The review of literature was conducted using systematic search of the database sources like PUBMED and EMBASE using appropriate keywords. The eligibility criteria and the data extraction of literature were based on study design (cohort or cross-sectional study), study population (orthopaedic surgeons or their assistants), exposure (doses of workplace radiation exposure at hands/fingers, eye/forehead, neck/thyroid), language (German and English). The literature search was conducted using a PRISMA checklist and flow chart.
  
  
  RESULTS
  Forty-two articles were found eligible and included for the review. The results show that radiation doses for the anatomical locations of eye, thyroid gland and hands were lower than the dose levels recommended. But there is a considerable variation of radiation dose received at all three anatomical locations mainly due to different situations including procedures (open and minimally invasive), work experience (junior and senior surgeons),distance from the primary and secondary radiation, and use of personal protective equipments (PPEs). The surgeons receive higher radiation dose during minimally invasive procedures compared to open procedures. Junior surgeons are at higher risk of radiation exposure compared to seniors. PPEs play a significant role in reduction of radiation dose.
  
  
  CONCLUSIONS
  Although the current radiation precautions appear to be adequate based on the low dose radiation, more in-depth studies are required on the variations of radiation dose in orthopaedic staff, at different anatomical locations and situations.
authors.affiliation: Centre for Epidemiology and Health Services Research in the Nursing Profession (CV care), University Medical Centre Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany. ckesavac@uke.uni-hamburg.de
authors.forename: Chandrasekharan Nair
authors.initials: CN
authors.lastname: Kesavachandran
authors.forename: Frank
authors.initials: F
authors.lastname: Haamann
authors.forename: Albert
authors.initials: A
authors.lastname: Nienhaus
mesh_terms: D004307:Dose-Response Relationship, Radiation; D005123:Eye / Q000528:radiation effects*; D005471:Fluoroscopy / Q000009:adverse effects; D006225:Hand / Q000528:radiation effects*; D006801:Humans; D016273:Occupational Exposure / Q000009:adverse effects / Q000032:analysis*; D009985:Orthopedics; D010564:Personnel, Hospital; D039781:PubMed; D011832:Radiation Injuries / Q000209:etiology*; D011839:Radiation, Ionizing; D013961:Thyroid Gland / Q000528:radiation effects; D000078329:Workforce