Michael M Vosbikian1, Asif M Ilyas2, Derek D Watson2, Charles F Leinberry2. 1. 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. 2. 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.
Abstract
PURPOSE: 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. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
PURPOSE: 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. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
Authors: Mark L Wang; C Edward Hoffler; Asif M Ilyas; William H Kirkpatrick; Pedro K Beredjiklian; Charles F Leinberry Journal: Hand (N Y) Date: 2016-04-06