Abstract

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.

• Keywords: Skin Neoplasms; Radiation, Ionizing; Basal Cell Carcinoma; Carcinoma, Squamous Cell; Fluoroscopy