title: Radiation exposure to hand surgeons' hands: a practical comparison of large and mini C-arm fluoroscopy.
abstract: OBJECTIVE
  To determine and compare the radiation exposure to surgeons' hands with large and mini C-arm fluoroscopy in a practical, clinically based model.
  
  
  METHODS
  Two hand surgeons monitored radiation exposure to their hands with a ring dosimeter over a 14-month period using large and mini C-arm fluoroscopic units. One surgeon performed all cases with a large C-arm unit in a hospital setting, and the other performed all cases with mini C-arms in surgical centers. For each case, fluoroscopic time, the output displayed by the unit, radiation by time, and ring dosimeter absorption were recorded and analyzed.
  
  
  RESULTS
  A total of 160 consecutive cases were reviewed with 71 cases and 89 cases in the large and mini C-arm groups, respectively. The median output displayed by the large C-arm was 0.7 mGy/case, and the median output displayed by the mini C-arm was 10.0 mGy/case. With output as a product of time, the median calculated values were 0.02 mGy/s for the large C-arm group and 0.28 mGy/s for the mini C-arm group. Cumulative ring dosimeter absorption to the surgeons' hands was found to be 380 mrem for 71 cases in the large C-arm group versus 1,000 mrem for 89 cases in the mini C-arm group.
  
  
  CONCLUSIONS
  In our model, the use of the mini C-arm resulted in more than a 10-fold increase in the rate of output and approximately double the dosimeter absorption to the surgeon's hand compared with the large C-arm. Although it has been shown that the mini C-arm produces less radiation scatter, in a practical model, it may not be a safer alternative with respect to the surgeon's hands. Based on these findings, we recommend that surgeons be more aware of radiation exposure risk, know their C-arm unit's specifications, and try to minimize radiation exposure.
  
  
  METHODS
  Prognostic II.
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital; the Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University Hospital; and the Department of Radiology, Nazareth Hospital, Philadelphia, PA. Electronic address: michael.vosbikian@gmail.com.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Vosbikian
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital; the Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University Hospital; and the Department of Radiology, Nazareth Hospital, Philadelphia, PA.
authors.forename: Asif M
authors.initials: AM
authors.lastname: Ilyas
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital; the Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University Hospital; and the Department of Radiology, Nazareth Hospital, Philadelphia, PA.
authors.forename: Derek D
authors.initials: DD
authors.lastname: Watson
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital; the Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University Hospital; and the Department of Radiology, Nazareth Hospital, Philadelphia, PA.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Leinberry
mesh_terms: D005471:Fluoroscopy / Q000295:instrumentation*; D006225:Hand / Q000528:radiation effects* / Q000601:surgery*; D006801:Humans; D016273:Occupational Exposure; D011446:Prospective Studies; D011829:Radiation Dosage; D011834:Radiation Monitoring / Q000295:instrumentation; D011835:Radiation Protection; D066231:Surgeons
keywords: Fluoroscopy; large C-arm; mini C-arm; radiation; radiation exposure