Annals of Occupational and Environmental Medicine

Case Report

Basal cell carcinoma and squamous cell carcinoma of the hands in an orthopedic surgeon with occupational radiation exposure from C-arm fluoroscopy in Korea: a case report: Jisue Yoon, Jihye Lee, Seongjin Jeong, Sangchul Roh, Min-Gi Kim, Jeongbae Rhie; Ann Occup Environ Med 2026;e25. Published online July 7, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e25 [Accepted]

Abstract PDF: Background
Occupational radiation exposure among medical professionals who use fluoroscopic devices is a well-recognized concern. While radiation-induced skin cancer has been reported in interventional radiologists, cases involving orthopedic surgeons with prolonged C-arm fluoroscopy exposure have rarely been described. We present a case of an orthopedic surgeon who developed basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) on the hands after approximately 30 years of occupational radiation exposure from C-arm use during orthopedic surgeries in Korea.
Case presentation
A 62-year-old male orthopedic surgeon who performed C-arm fluoroscopy-assisted surgeries for 30 years without radiation-protective gloves presented with bleeding and skin lesions on his left hand. Hospital records documented an average of 314 C-arm-assisted surgeries per year with an estimated annual C-arm usage of 12,397 minutes. An on-site radiation assessment was conducted in the actual operating room using a simulated patient, with positioning replicated via structured interview. Measurements using an X/gamma survey meter at the surgeon's hand position yielded mean equivalent dose rate of 3.5 mSv/h and a maximum of 5.0 mSv/h, corresponding to estimated annual equivalent doses of 723 and 1,033 mSv/y, both exceeding the regulatory equivalent dose limit for extremities in Korea. The patient had experienced recurrent blistering on both hands for approximately 10 years. Biopsy revealed BCC on the left thumb and SCC on the left second and third fingers, with bilateral chronic radiation dermatitis. Excision and skin grafting were performed on the affected fingers.
Conclusions
This case demonstrates that prolonged C-arm fluoroscopy exposure without adequate hand protection can lead to radiation-induced skin cancers in orthopedic surgeons. The marked discrepancy between trunk-mounted dosimeter readings and estimated hand doses underscores the need for extremity-specific dosimetry. Radiation-protective gloves and regular dermatologic surveillance are essential for medical professionals exposed to ionizing radiation during fluoroscopy-guided procedures.

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Original Article

Relationship between organophosphate and pyrethroid pesticides and metabolic syndrome in Korean farmers: Sungbeom Kim, Sangchul Roh, Min-Gi Kim, Jeongbae Rhie, Jisue Yoon, Sun-In Moon; Ann Occup Environ Med 2024;36:e23. Published online September 20, 2024; DOI: https://doi.org/10.35371/aoem.2024.36.e23

Background
The global use of pesticides steadily increased until the early 2010s. Pesticides play a significant role in agriculture in Korea. Metabolic syndrome is more prevalent in rural areas than in urban areas. This study explored the potential association between organophosphate and pyrethroid pesticide exposure and metabolic syndrome.
Methods
This study enrolled 1,317 individuals who participated in the Pesticide Exposure and Intoxication Study conducted by the Dankook University Hospital Center for Farmers’ Safety and Health from 2014 to 2019. Urinary levels of dimethylphosphate, dimethylthiophosphat, diethylphosphate, and diethylthiophosphate were measured to assess organophosphate pesticide exposure and urinary levels cis-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid, trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid, cis-3-(2,2-dibromovinyl)-2,2-dimethylcyclopropane carboxylic acid, and 3-phenoxybenzoic acid were measured to assess pyrethroid pesticide exposure.
Results
The odds ratio for the 4th quartile group of organophosphate metabolites concentration was 1.48 (95% confidence interval: 1.06–2.09) compared to the 1st quartile group after adjustment for general factors. In addition, a positive trend was observed across the quartile groups of organophosphate metabolites concentration. A positive trend was noted across the quartile groups of organophosphate metabolites in males, while no significant association was observed in females. Furthermore, no significant associations were observed between metabolic syndrome and pyrethroid metabolites concentration.
Conclusions
A positive correlation was observed between the prevalence of metabolic syndrome and the concentrations of urinary organophosphate metabolites, consistent with previous research finding. This association may be attributed to the action of organophosphates as acetylcholinesterase inhibitors, stimulating beta cells in the islets of Langerhans. This can lead to alterations in lipid metabolism and insulin resistance, ultimately leading to metabolic syndrome development. Metabolic syndrome is a major contributor to cardiovascular disease; therefore, it is necessary to identify the risk factors unique to rural areas, such as pesticide exposure.

한국 농업인의 유기인계 및 피레스로이드계 농약과 대사증후군 간의 관계
목적
농약 사용량은 2010년대 초까지 전세계적으로 꾸준히 증가하였으며, 농약은 한국 농업에서 중요한 부분을 차지하고 있다. 대사 증후군은 농촌 지역에서 도시 지역에 비하여 높은 유병률을 보인다. 유기염소계 농약과 대사 증후군 사이의 관련성은 일부 연구된 바 있으나, 다른 종류의 농약 노출과 대사 증후군 사이의 관련성에 대한 연구는 제한적이다. 따라서 본 연구는 유기인계 및 피레스로이드계 농약의 노출과 대사 증후군 사이의 관련성을 조사하고자 한다.
방법
2014년부터 2019년까지 단국대학교병원 농업안전보건센터에서 실시한 농약 노출 및 중독 연구에 참여한 1,317명을 대상으로 연구를 진행하였다. 유기인계 농약 노출 평가를 위해 DMP, DMTP, DEP, DETP의 소변 농도를 측정하였고, 피레스로이드계 농약 노출 평가를 위해 cis-DCCA, trans-DCCA, DBCA, 3-PBA의 소변 농도를 측정하였다. 다변량 로지스틱 회귀분석을 시행하여 농약 노출과 대사증후군 유병률 사이의 관계를 조사하였다.
결과
유기인계 대사체 농도에 따라 4분위 그룹으로 분류하였을 때, 4분위 그룹의 대사증후군 유병률이 오즈비 1.66(95% CI 1.22-2.28)으로 1분위 그룹에 비하여 높았다. 또한, 유기인계 대사체 농도와 대사증후군 유병률은 유의한 경향성을 보였다. 피레스로이드계 대사체 농도에 따라 4분위 그룹으로 분류하였을 때, 3분위 그룹의 대사증후군 유병률이 오즈비 1.51(95% CI 1.11-2.07)로 1분위 그룹에 비하여 높았다. 피레스로이드계 대사체 농도와 대사증후군 사이에 유의한 경향성은 나타나지 않았다.
결론
유기인계 농약 대사체 농도와 대사 증후군의 유병률 사이에 양의 상관 관계가 관찰되었으며, 이전 연구 결과를 보충하는 결과로 나타났다. 대사 증후군의 유병률이 증가하는 기전은 불분명하나, 유기인계 농약은 acetylcholinesterase inhibitor로 작용하므로 랑게르한스 섬의 베타 세포를 자극하고 이에 따른 지질 대사 및 인슐린 저항성의 변화로 인해 나타날 수 있을 것으로 추정된다. 대사 증후군은 심혈관 질환의 주요 원인 중 하나이며, 농촌 지역에서는 의료 접근이 비교적 취약하며 농약과 같은 특수한 위험 요인이 있기 때문에 이러한 위험 요인들을 식별하고 예방하여야 한다.

Citations

Citations to this article as recorded by

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