Radiation Exposure and Hand Dominance Using Mini C-Arm Fluoroscopy in Hand Surgery

Abstract

Background: The mini C-arm is popular with hand surgeons, and they are particularly at risk for radiation exposure, as they cannot easily distance themselves from the radiation beam. We hypothesized that the nondominant hand receives more radiation exposure than the dominant hand as it is generally closer to the radiation source. This study seeks to determine whether a hand surgeon receives a different amount of radiation exposure to their hands based on hand dominance and then accounting for this, provide a more accurate assessment of hand radiation exposure from mini C-arm fluoroscopy. Methods: Two fellowship-trained hand surgeons wore ring dosimeters on both hands during surgeries with mini C-arm fluoroscopy involving bony work of the forearm and hand. Radiation exposure to the hands was measured from ring dosimeters. Results: Six-ring dosimeter pairs were worn during 64 cases, averaging 10.7 cases per ring. No ring met the minimal dose threshold of 30 mrem to record a numerical value. Each ring experienced an average of 413 seconds of fluoroscopy time and 66.3509 cGy*cm² of radiation output from the mini C-arm. Conclusions: The results do not allow comparison of radiation exposure related to hand dominance. Assuming worst-case scenario: each ring measured 29 mrem (just below the threshold), the surgeon’s hands experienced 2.7 mrem per case. This would allow a hand surgeon to perform 18 391 cases per year before exceeding the allowable annual hand exposure limit of 50 000 mrem set by the National Council of Radiation Protection and Measurements and International Commission on Radiological Protection.