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Hand surgeons may be exposed to significant radiation using mini C-arm fluoroscopy

Issue: October 2004

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NEW YORK — Hand surgeons who use a mini C-arm fluoroscopic unit should consider using precautions to protect themselves from radiation exposure, according to results presented at the American Society for Surgery of the Hand 59th Annual Meeting.

As the indications for intraoperative fluoroscopy expand, it is critical to know how much radiation hand surgeons are being exposed to, said Gordon M. Singer, MD, of Denver, Colo. “Hand surgeons must work close to the beam and cannot use distance to reduce their exposure. There is very little information available regarding radiation exposure from the mini C-arm fluoroscopy.”

In this the first study to evaluate surgeon radiation exposure, Singer sought to quantify the radiation exposure using the mini C-arm.

Five surgeons wore ring dosimeters on their nondominant index fingers to measure radiation exposure to their hands during surgery. The ring dosimeters contain a lithium fluoride chip that measures a wide range of exposure from 1 mRem to 100,000 Rem. One ring was used for each surgery.

Hands exposed to radiation

Results showed that surgeons’ hands are exposed to an average of 20 mRem per case. “For comparison, an average chest x-ray exposure is 20 mRem. So, in other words, surgeons’ hands are getting the equivalent of a chest x-ray with each surgery,” Singer said.

On average, surgeons used 51 seconds of fluoroscopy time per case (range 6 seconds to 170 seconds). “The amount of exposure did not increase as fluoroscopy time increased,” he added.

For the scatter portion, Singer obtained data for both the small (for hand, wrist and foot cases) and large C-arm (for hip and spine cases) on how quickly the radiation dropped off when working near the beam. He obtained data every 5 cm from beam center.

“The radius of the mini C-arm intensifier is 10 cm. The radiation at the center was 57 mRem per minute while at the edge of the intensifier it dropped to below 1 mRem per minute and then smaller as it went further,” Singer said during his presentation. The results for the large C-arm were similar.

The accepted annual limits for total or whole body exposure vary from 2000 mRem (international) to 5000 mRem (United States). The annual dose permitted for the extremities is 50,000 mRem.

“When comparing the actual exposure to recommended limits, an exposure to the hand of 20 mRem per case in comparison to an annual limit of 50,000 mRem would allow 2500 cases per year,” Singer said. “Exposure at the edge was less than 1 mRem and the annual limit would allow either 2000 or 5000 mRem.

For more information:

• Singer G. Radiation exposure to the hands of hand surgeons using mini C-arm fluoroscopy. #18B. Presented at the American Society for Surgery of the Hand 59th Annual Meeting. Sept. 9-11, 2004. New York.