{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T09:32:29Z","timestamp":1780047149237,"version":"3.53.1"},"reference-count":18,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2021,3,6]],"date-time":"2021-03-06T00:00:00Z","timestamp":1614988800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Hand (New York, N,Y.)"],"published-print":{"date-parts":[[2023,1]]},"abstract":"\n Background:<\/jats:title>\n Diagnostic reference levels are radiation dose levels in medical radiodiagnostic practices for typical examinations for groups of standard-sized individuals for broadly defined types of equipment. This study aimed to contribute to national diagnostic reference levels for common hand and wrist procedures using mini C-arm fluoroscopy. Small joint and digital fracture procedure diagnostic reference levels have not been reported in significant numbers previously with procedure-level stratification.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Data were collected from fluoroscopy logbooks and were cross-referenced against the audit log kept on fluoroscopy machines. A total of 603 procedures were included.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n The median radiation dose for wrist fracture open fixation was 2.73 cGycm\n 2<\/jats:sup>\n , Kirschner wiring (K-wiring) procedures was 2.36 cGycm\n 2<\/jats:sup>\n , small joint arthrodesis was 1.20 cGycm\n 2<\/jats:sup>\n , small joint injections was 0.58 cGycm\n 2<\/jats:sup>\n , and phalangeal fracture fixation was 1.05 cGycm\n 2<\/jats:sup>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Wrist fracture fixation used higher radiation doses than phalangeal fracture fixation, arthrodeses, and injections. Injections used significantly less radiation than the other procedures. There are significant differences in total radiation doses when comparing these procedures in hand and wrist surgery. National and international recommendations are that institutional audit data should be collected regularly and should be stratified by procedure type. This study helps to define standards for this activity by adding to the data available for wrist fracture diagnostic reference levels and defining standards for digital and injection procedures.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/1558944721994257","type":"journal-article","created":{"date-parts":[[2021,3,6]],"date-time":"2021-03-06T05:46:21Z","timestamp":1615009581000},"page":"153-157","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Diagnostic Reference Levels for Common Orthopedic Hand and Wrist Procedures Using Intraoperative Mini C-arm Fluoroscopy"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3694-3030","authenticated-orcid":false,"given":"Kiran R.","family":"Madhvani","sequence":"first","affiliation":[{"name":"Rotherham General Hospital, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J. R.","family":"Clark","sequence":"additional","affiliation":[{"name":"Rotherham General Hospital, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex A. J.","family":"Kocheta","sequence":"additional","affiliation":[{"name":"Rotherham General Hospital, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,3,6]]},"reference":[{"key":"bibr1-1558944721994257","unstructured":"World Health Organization. Diagnostic imaging: fluoroscopy. Date unknown. https:\/\/www.who.int\/diagnostic_imaging\/imaging_modalities\/dim_fluoroscopy\/en\/. Accessed November 26, 2019."},{"key":"bibr2-1558944721994257","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0901249"},{"key":"bibr3-1558944721994257","doi-asserted-by":"publisher","DOI":"10.2478\/v10001-009-0010-y"},{"key":"bibr4-1558944721994257","doi-asserted-by":"publisher","DOI":"10.1007\/s13244-015-0410-4"},{"key":"bibr5-1558944721994257","unstructured":"US Nuclear Regulation Committee. 10 CFR: part 20\u2014Standards for protection against radiation. Date unknown. https:\/\/www.nrc.gov\/reading-rm\/doc-collections\/cfr\/part020. Accessed December 10, 2019."},{"key":"bibr6-1558944721994257","first-page":"271","volume-title":"Advances in Medical Physics","volume":"2016","author":"Battista JJ"},{"key":"bibr7-1558944721994257","doi-asserted-by":"publisher","DOI":"10.1148\/rg.285075748"},{"key":"bibr8-1558944721994257","unstructured":"Department of Health & Social Care. Ionising radiation (medical exposure) regulations 2017: guidance. Date unknown. https:\/\/www.gov.uk\/government\/publications\/ionising-radiation-medical-exposure-regulations-2017-guidance. Accessed December 9, 2019."},{"key":"bibr9-1558944721994257","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.74.885.740785"},{"key":"bibr10-1558944721994257","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20150373"},{"key":"bibr11-1558944721994257","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2015.10.010"},{"key":"bibr12-1558944721994257","unstructured":"Public Health England. National Diagnostic Reference Levels (NDRLs) from 19 August 2019. Date unknown. https:\/\/www.gov.uk\/government\/publications\/diagnostic-radiology-national-diagnostic-reference-levels-ndrls\/ndrl#national-drls-for-general-radiography-and-fluoroscopy. Accessed December 10, 2019."},{"issue":"1","key":"bibr13-1558944721994257","first-page":"7","volume":"20","author":"Lee YS","year":"2015","journal-title":"J Res Med Sci"},{"key":"bibr14-1558944721994257","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-017-2020-y"},{"key":"bibr15-1558944721994257","doi-asserted-by":"publisher","DOI":"10.1177\/1753193419848575"},{"key":"bibr16-1558944721994257","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2005.06.023"},{"key":"bibr17-1558944721994257","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2011.01.010"},{"key":"bibr18-1558944721994257","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.00407"}],"container-title":["HAND"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1558944721994257","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1558944721994257","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1558944721994257","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:27:56Z","timestamp":1777447676000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1558944721994257"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,6]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1177\/1558944721994257"],"URL":"https:\/\/doi.org\/10.1177\/1558944721994257","relation":{},"ISSN":["1558-9447","1558-9455"],"issn-type":[{"value":"1558-9447","type":"print"},{"value":"1558-9455","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,6]]}}}