Radiation exposure in hand surgery: Mini versus standard C-arm

Purpose: The use of intraoperative fluoroscopy in hand surgery is common. Two types of fluoroscopic units are available: the mini C-arm and the standard C-arm. There is little literature on the radiation exposure from the mini C-arm, therefore, the primary goal of this study was to quantify and compare the amount of radiation exposure to members of the surgical learn (surgeon, first assistant, nurse, anesthesiologist) using both standard and mini C-arms in a simulated wrist surgery setup. Mini C-arm positioning was also examined to determine the safest configuration to minimize radiation exposure to surgeons. Methods: Radiation dosimeters were used to test 2 commercially available fluoroscopy units in a simulated wrist surgery setup with a cadaveric upper extremity. Several different configurations of the C-arms were tested to determine radiation exposure rates to surgeons and the operating room staff. Results: The mean in-beam radiation exposures with the use of the mini and standard C-arms were 3,720 mR/h and 6,540 mR/h, respectively. The mini C-arm had universally less radiation exposure than the standard C-arm in the clinical configurations tested. The safest configuration of mini C-arm use to minimize radiation exposure was with the surgeon standing on the image intensifier side of the unit as compared with the source side. Mini C-arm radiation exposure to the hands, groin, chest, and thyroid of the operating surgeons were well below the National Council of Radiation Protection and Measurement's annual dose limits. Conclusions: In the clinical configurations tested in this study the mini C-arm had lower radiation exposures than the standard C-arm. To reduce radiation exposure maximally surgeons should stand behind the lead-encased image intensifier and should use techniques to reduce exposure.