Radiation Exposure to the Thyroid, Groin and Eyes in Seated Orthopaedic Surgeries with Real-Time Clinical Correlations

Radiation Exposure to the Thyroid, Groin and Eyes in Seated Orthopaedic Surgeries with Real-Time Clinical Correlations | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Radiation Exposure to the Thyroid, Groin and Eyes in Seated Orthopaedic Surgeries with Real-Time Clinical Correlations Kai-Xing Alvin Lee, Hao-Wei Chang, Chin-Jung Hsu, Chun-Hao Tsai, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8660309/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract Background Fluoroscopic imaging is indispensable in orthopaedic surgery but exposes surgeons to scatter radiation. Protective lead gowns reduce exposure, but differences in gown design, C-arm orientation, and seated positioning may influence protection efficiency at critical anatomical sites. Eye exposure is of particular concern due to the revised occupational dose limit of 20 mSv/year by the International Commission on Radiological Protection (ICRP). This study aimed to quantify scatter radiation exposure at the eye, thyroid, and groin under different gown configurations and positions during seated fluoroscopy. Our study was the first study to incorporate clinical parameters and settings into our study design. Methods Radiation exposure experiments were performed using a standardized C-arm fluoroscopy setup (46 kVp, 0.61 mA) with a full-sized mannequin seated at an orthopaedic surgical arm table. Raysafe i3 dosimeters were placed externally (outside gown) and internally (beneath gown) at the eye, thyroid, and groin. Two protective gowns were tested: a two-piece skirt–vest and a one-piece cross-back gown. Three seated positions were evaluated: (i) upright with knees 15 cm apart, (ii) inverted C-arm with knees 15 cm apart, and (iii) upright with knees 45 cm apart. Continuous fluoroscopy was applied for 1, 3, and 5 minutes. Mean values were analyzed using two-way ANOVA (gown × position) and regrouped for upright versus inverted C-arm comparisons, with effect sizes (η², Cohen’s d ) calculated. Results Internal eye doses ranged from 0.1–3.8 µSv with the one-piece gown and 0.2–1.7 µSv with the two-piece gown, corresponding to 19–91% reductions compared to external measurements. Two-way ANOVA showed that position significantly affected internal eye dose (F(2,14) = 7.93, p = 0.005, η² = 0.51, large), while gown type had no significant effect (F(1,14) = 1.28, p = 0.276). External eye doses were not significantly influenced by either factor. When regrouped by C-arm orientation, inverted positioning produced significantly higher internal eye doses (F(1,16) = 16.59, p = 0.0009, Cohen’s d = − 2.04, very large). External doses trended higher in inverted orientation but were not statistically significant (F(1,16) = 2.56, p = 0.129, d = − 0.80). Internal thyroid and groin exposures were consistently 0 µSv across all conditions, corresponding to complete protection, while external values increased with time and position. Conclusions Protective lead gowns provided complete shielding at the thyroid and groin, but ocular exposure remained strongly dependent on C-arm orientation and body positioning. The inverted C-arm significantly increased ocular dose despite gown use, underscoring the vulnerability of the lens to scatter radiation. Gown design alone did not significantly alter protection to the eyes. These findings support strict adherence to upright C-arm orientation whenever feasible, routine thyroid collar use, and adoption of lead glasses to further reduce ocular risk. Optimizing fluoroscopic setup and reinforcing protective practices remain essential to minimizing occupational radiation hazards in orthopaedic surgery. This study is the first to evaluate scatter radiation exposure using clinically measured, real-time surgeon positioning during seated orthopaedic fluoroscopy. Orthopaedic surgery Scatter radiation Lead gown protection C-arm fluoroscopy Occupational exposure Figures Figure 1 Figure 2 Introduction Fluoroscopic imaging is indispensable in orthopaedic trauma surgery, and it exposes surgeons and operating room staff to ionizing radiation. Both primary and scatter radiation can pose occupational hazards, with cumulative exposure linked to cataracts, infertility, and malignancy [ 1 ]. Evidence from the Atomic Bomb Survivors Life-Span Study, which followed 50,000 survivors within 3 km of the Hiroshima and Nagasaki epicenters, highlighted the long-term health effects of radiation doses ≥ 500 mSv [ 2 ]. In response, the International Commission on Radiological Protection (ICRP) has progressively tightened occupational dose limits, most notably reducing the annual lens threshold from 150 to 20 mSv to address cataract risk, while maintaining a 500 mSv annual limit for skin exposure [ 3 ]. To mitigate intraoperative risks, protective gowns such as lead gowns, thyroid collars, and lead glasses are recommended, alongside institutional safeguards including regular equipment checks and staff dosimetry [ 4 , 5 ]. Nonetheless, scatter radiation from the C-arm remains a major source of exposure during procedures, and several factors influence dose magnitude—particularly gown design, C-arm orientation, and surgeon positioning [ 6 ]. Prior studies suggest that gown skirts may separate during seated procedures, potentially compromising gonadal protection, and that inverted C-arm positioning can redirect scatter upward toward the surgeon’s head and eyes [ 7 ]. These scenarios are particularly common in orthopaedic trauma surgery. When operating on the hand or other small joints, surgeons often adopt a seated position to enhance manual stability during delicate procedures. As a result, prolonged seated operation and challenging fluoroscopic angles are frequently encountered in clinical practice [ 1 , 5 , 8 , 9 ]. Despite these risks, there is limited evidence quantifying how different gown designs and seated positions under varying C-arm orientations affect radiation exposure. Understanding these dynamics is critical to refining occupational safety protocols. There are currently several isolated studies examining regarding radiation exposure and cataract risks, testicular and thyroid exposures [ 1 , 9 ]. However, more studies are required to value-add to these results by examining for various realistic situations. Our study was the first to correlate clinical parameters, including height, distance between knees apart, distance between arms apart, distance from thoracic region to edge of table, distance from table to arm of C-arm and distance from table to transducer or receiver of C-arm. We collated real-time duration of radiation exposure for several common seated surgical procedures and the clinical parameters and datas were incorporated into our study design. In addition, we conducted a simple interview of all of our Orthopaedic surgeons and the three main worries were radiation exposure risks between gown designs, inverted C-arm exposures and radiation exposure to the gonadal region during seated positions. Therefore, this study aimed to measure scatter radiation under two gown designs (two-piece skirt-vest vs. one-piece cross-back) across multiple seated positions, including upright and inverted C-arm use. Internal (beneath the gown) and external (outside the gown) doses were recorded at the eye, thyroid, and groin over 1-, 3-, and 5-minute fluoroscopy intervals. Our primary objective was to assess protective efficiency and clarify whether seated posture and C-arm orientation outweigh gown design in determining exposure risk. The secondary objective was to assess if inverted and upright C-arm positions had a role to play in radiation exposure to the eyes. Unlike prior phantom or dosimetry studies that rely on standardized or idealized operator positioning, the present study was specifically designed to replicate real-time clinical operating conditions. Surgeon-specific measurements—including seated posture, knee separation, arm position, and C-arm geometry—were incorporated directly into the experimental setup based on observed intraoperative practice. To our knowledge, this is the first study to correlate scatter radiation exposure with clinically derived, real-world surgeon positioning during seated orthopaedic procedures, thereby bridging the gap between experimental dosimetry and operative reality. Materials and methods Radiation exposure experiments were performed using a standardized C-arm orthopaedic fluoroscopy setup (Siemens Cios Flow.neo; USA; 46 kVp, 0.61 mA). Dosimeters (Raysafe i3; Sweden) were positioned at the eye, thyroid, and groin levels to capture scatter dose in two conditions: external (outside the gown) and internal (beneath the gown) (Fig. 2 A). A total of 6 portable dosimeters were thus placed on the mannequin. Calibration is conducted according to manufacturer’s instructions prior to our evaluation. The detection limit of the dosimeter is < 30 microsieverts (µSv). In this study, we collated clinical parameters of 38 Orthopaedic surgeons from our hospital when utilizing C-arm and operating under seated conditions, including height, distance between knees apart, distance between arms apart, distance from thoracic region to edge of table, distance from table to arm of C-arm and distance from table to transducer or receiver of C-arm. These results were as shown in Table 1 A and Fig. 1 . A seated full-sized mannequin (170 cm was chosen) was used to simulate the orthopaedic surgeon operating on a radiolucent surgical arm table (Fig. 2 B). Importantly, all positional parameters used in this study—including knee separation, arm spacing, torso-to-table distance, and C-arm alignment—were derived from direct measurements of practicing orthopaedic surgeons during routine seated procedures, ensuring close correlation with real-time clinical workflow rather than theoretical positioning. The dimensions of the torso corresponded to medium-sized protective lead gowns according to the manufacturer’s sizing chart. Two protective gown designs were evaluated: a two-piece lead skirt-vest and a one-piece cross-back gown. Both protective lead gowns were commercially available products commonly used in clinical practice. The two-piece skirt–vest apron and the one-piece cross-back apron were manufactured with a nominal lead equivalence of 0.5 mm Pb at 80 kVp, consistent with standard occupational radiation protection requirements. Lead glasses were worn by the mannequin in all experimental conditions. The lead glasses had a nominal lead equivalence of 0.5 mm Pb and were kept constant throughout all measurements. Therefore, differences in radiation exposure observed in this study were not attributable to disparities in lead thickness but rather to gown configuration, surgeon posture, and C-arm orientation. Three body positions were tested under fluoroscopy: Group 1 and 2 — Seated with knees 15 cm apart (C-arm upright and inverted) (Fig. 2 C). Group 3 — Seated with knees 45 cm apart (C-arm upright) (Fig. 2 B). For all positions, the back and hip of the mannequin was erected seated in-line with the back support of the surgical chair. The surgical arm table was placed 30 cm from the thoracic region of the mannequin and the arms were placed 30 cm apart (Fig. 2 B). The distance from the thoracic to edge of table was 30 cm, distance from edge of table to arm of C-arm was 90 cm and distance from table to transducer or receiver of C-arm was 90 cm (Fig. 2 C). In addition, we collated the average total fluroscopy exposure for various types of seated surgical procedures including distal radius fracture, distal radio-ulnar fractures, metacarpal fractures (plating and closed reduction with pining or nailing), and forearm two bones fractures (Table 1 B). A total of 10 surgical procedures each were collated for this study. Using this data as a guide, fluoroscopy was activated continuously for 1, 3, and 5 minutes in this study. Five tests were done for each group with the averages recorded. Doses were recorded in µSv. Statistical analyses Descriptive statistics (mean values across 1, 3, and 5 minutes) were reported for each condition. Percentage reduction was calculated as Percentage of Reduction = [(External−Internal​)/ External] × 100%. Differences between gown types (two-piece vs. one-piece) and experimental positions (upright, inverted, wide stance) were evaluated using two-way analysis of variance (ANOVA) without replication, stratified by anatomical site. For the eyes, effect sizes (η², eta squared) were calculated to quantify the proportion of variance explained by each factor. Cohen’s conventions were used (η² = 0.01 small, 0.06 medium, 0.14 large). To specifically examine the effect of C-arm orientation, eye doses were regrouped into Upright (upright + wide stance) and Inverted conditions. One-way ANOVA was used to compare these two orientations, with Cohen’s d reported as a standardized effect size (0.2 small, 0.5 medium, 0.8 large). A p-value < 0.05 was considered statistically significant. All analyses were performed in SPSS (Version 20). Results The cumulative exposure for two-piece lead gowns (3 groups with eye, thyroid and groin) and one-piece lead gown (3 groups with eye, thyroid and groin) were as shown in Tables 2 and 3 respectively. The ANOVA and Cohen’s d analysis between gown types and body positions for eyes were as shown in Table 4. The results were displayed as per anatomical part below. Eye exposure In the one-piece gown group, internal eye doses reached 0.1–3.8 µSv, while external ranged 0.5–4.7 µSv, giving reductions of 19% to 89%. In the two-piece gown, eye doses ranged from 0.2 µSv (1 min, upright) to 1.7 µSv (5 min, inverted) internally, compared with 0.4–3.0 µSv externally, corresponding to reductions of 33% to 91%. Two-way ANOVA for eye exposure showed that position (upright, inverted, seated 45 cm knees apart) had a significant effect on internal doses (F(2,14) = 7.93, p = 0.005, η² = 0.51), indicating that body stance and C-arm orientation accounted for more than half of the variance. In contrast, gown type (two-piece vs. one-piece) did not significantly influence internal eye dose (F(1,14) = 1.28, p = 0.276, η² = 0.04). For external eye exposure, neither gown type (F(1,14) = 1.34, p = 0.266, η² = 0.07) nor position (F(2,14) = 1.37, p = 0.286, η² = 0.15) reached statistical significance, although effect sizes suggested small to moderate contributions. Our team hypothesized that C-arm orientation has a role to play in eye exposure. The inverted C-arm in both groups had the highest exposure due to proximity of the X-ray source and scatter radiation to the eyes. In addition, lead glasses provided lower protection for the inverted C-arm group (19.1% to 43.3%) as compared to the upright group (50% to 90.5%). When regrouped by C-arm orientation, internal eye dose was significantly higher in the inverted position compared with upright (F(1,16) = 16.59, p = 0.0009, Cohen’s d = − 2.04, very large effect). External doses trended higher in the inverted orientation as well, but this difference was not statistically significant (F(1,16) = 2.56, p = 0.129, Cohen’s d = − 0.80, large effect). Thyroid exposure Internal thyroid doses were consistently below minimum detectability of dosimeter in both gown types across all conditions, while external readings ranged from 0.4–3.4 µSv, reflecting approximately full protection. Groin exposure With the two-piece gown, internal groin doses were below minimum detectability of dosimeter, whereas external ranged 0.1–2.3 µSv, yielding approximately full protection. With the one-piece gown, groin internal values remained below minimum detectability of dosimeter, with external up to 3.5 µSv, also showing approximately full protection. Because the experimental configuration reflected clinically measured surgeon posture and fluoroscopic setup, the observed dose differences directly reflect real-world intraoperative exposure patterns rather than abstract dosimetric models. Discussions This study evaluated scatter radiation exposure at the eye, thyroid, and groin using a mannequin model under different protective gown designs and C-arm orientations. The results highlight the relative strengths of protective gowns and the dominant role of operator positioning in determining dose distribution. Our study proved that both types of protective gowns are effective in provention of intraoperative scatter radiation to thyroid and groin region. Furthermore, the protection was effective regardless of seated knees in narrow (15 cm) or wide (45 cm) positions. It was initially hypothesized that sitting with the one-piece protective gown might expose the groin region to radiation due to splitting of the one-piece design, especially so for the knees wide apart position. Both types of protective gowns significently reduced radiation exposure to below detection limit of dosimeter. A key strength of this study lies in its direct correlation with real-time clinical practice. Previous investigations have often assessed radiation exposure under fixed or idealized conditions, without accounting for surgeon-specific posture or seated operating geometry. In contrast, our study incorporated measured intraoperative parameters from practicing orthopaedic surgeons, allowing scatter radiation patterns to be evaluated in a manner that closely reflects day-to-day operative conditions. This approach enhances the clinical validity of our findings and may explain the large effect sizes observed with changes in C-arm orientation. The eye remained the most vulnerable site despite protective glasses, with detectable internal doses across all conditions. Two-way ANOVA confirmed that position significantly influenced internal eye dose (F(2,14) = 7.93, p = 0.005, η²=0.51, large effect), while gown type did not. When regrouped by C-arm orientation, inverted positioning produced substantially higher internal doses than upright (F(1,16) = 16.59, p = 0.0009; Cohen’s d=–2.04, very large effect). External doses trended higher in the inverted orientation as well, though this did not reach significance. These findings suggest that scatter directed upward in inverted geometry increases ocular exposure, overwhelming the modest differences between the groups. Reported protection efficiencies were lowest in the inverted group (19–43%) compared with upright (50–91%), underscoring the importance of avoiding inverted C-arm use whenever feasible and reinforcing the value of adjunct eye shielding such as lead glasses. There are increased evidences and publications showing that low-dose, long-term radiation exposure leads to cataract formation [ 4 , 10 – 12 ]. Interventional radiologists and cardiologists exposed to chronic scatter show higher rates of lens opacities compared with unexposed groups, with prevalence estimates up to 16–17% in some cohorts [ 13 ]. Epidemiological reviews suggest that the threshold for radiation-induced cataracts may be far lower than previously assumed, prompting the ICRP to reduce the annual occupational limit for the lens to 20 mSv [ 14 ]. Recent dosimetry studies confirm that orientation and positioning of the C-arm strongly influence lens dose, and that protective eyewear significantly mitigates, but does not eliminate risk [ 15 – 17 ]. Although lead glasses were used in all experimental conditions, internal eye dose remained strongly dependent on C-arm orientation. This finding suggests that while lead eyewear provides baseline protection, it cannot fully mitigate the increased scatter radiation directed toward the eyes during inverted C-arm positioning. In contrast, the neck collar provided complete attenuation, with internal doses consistently undetectable (below detectable limits) under both gown types across all positions and timepoints. External thyroid values increased with time but did not translate to internal exposure, demonstrating the effectiveness of neck collars and gown overlap when correctly positioned. These findings support existing guidelines that mandate routine thyroid collar use in all fluoroscopic procedures [ 18 ]. Similarly, groin protection for both two-piece and one-piece gowns were effective, with all internal readings below the detection threshold. These results reaffirm the importance of protective gowns, regardless of designs, and show that, when fitted correctly, both designs provide equivalent protection at the gonads. Occupational radiation to the testicular region has been highlighted as an underappreciated risk among orthopaedic surgeons [ 8 ]. Phantom studies simulating operative positions demonstrated that gown type and seating posture influence scatter reaching the gonads, with gaps in lead skirt coverage during seated procedures leading to increased testicular exposure. Clinical observations also suggest possible downstream effects: a nationwide survey of Japanese doctors reported a higher female-to-male offspring ratio among orthopaedic surgeons chronically exposed to fluoroscopy, raising concerns about gonadal radiation effects on fertility [ 19 ]. Although diagnostic imaging studies confirm that direct shielding can markedly reduce testicular dose during CT examinations, real-world surgical data remain limited, and published evidence emphasizes the importance of secure gown overlap, particularly when the surgeon is seated for prolonged procedures. Our studies further showed that all gown types are suitable for protection, regardless of knee positioning. Our study was not without limitations. This study was conducted in a simulated mannequin model without patient variability, body habitus differences, or dynamic operator movement. Doses were measured at fixed locations and averaged across short exposures (1–5 minutes). While these conditions allow controlled comparisons, real surgical scenarios may involve higher variability. Furthermore, as our dosimeter had a detection limit of 30 µSv, therefore any ionizing radiation below this limit were not recorded. In addition, our study was conducted with the mannequin seated in static position, which might not be realistic in real-world model. Even with ICRP and local institutions emphasis on radiations safety, a survey in 2021 showed that orthopaedic surgeons were still unclear regarding radiation safety, C-arm usage and radiation principles. From our results, we strongly advocate to prioritize upright C-arm orientation whenever clinically possible, minimize wide stance and inverted positioning, standardize use of thyroid collars and lead skirts, and to adopt lead glasses as routine adjunct protection. To our knowledge, this is the first investigation to integrate gown design, seated surgeon posture, and C-arm orientation using clinically derived measurements to assess radiation exposure at the eye, thyroid, and groin. By aligning experimental design with real-time practice, our findings provide actionable insights that can be immediately translated into operative behavior and institutional radiation safety policies. Conclusion Protective lead gowns provide complete shielding at the thyroid and groin, but ocular exposure remains position-dependent. Although this study was performed using a standardized mannequin model, the findings provide several clinically relevant insights. Inverted C-arm positioning should be avoided when feasible, as it was consistently associated with higher internal ocular exposure. Routine use of lead glasses remains advisable given that measurable eye doses occurred under all conditions. In contrast, the thyroid collar and lead gowns reliably reduced thyroid and groin exposure to below the detection threshold, and both one-piece and two-piece designs offered comparable protection. Declarations Ethical review and Consent to participate Not applicable. This study did not involve human participants or patient-related data. The experimental protocol used a mannequin model only. Surgeon-related clinical parameters were recorded in a de-identified manner and contained no personally identifiable information; therefore, informed consent and ethical approval was waived by China Medical University Hospital Institutional Review Board. Informed consent for 1 participant was obtained for the representative image in the Figure section. Consent for publication Not applicable Conflict of interest statement Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. Authors’ contributions Kai-Xing, Alvin Lee and Hao-Wei Chang conceptualized the study design and drafted the article. Chin-Jung Hsu, Chun-Hao Tsai were in-charge of compiling and tabulating data. Cheng-Di Chiu and Shih-Han Lee were involved in managing logistical arrangements. Hsien-Te Chen and Chia-Yu Lin were the attending surgeon in charge and Chia-Yu Lin was the corresponding author. The authors read and approved the final manuscript. Availability of data and materials All data generated in this study are included in this article. Funding No fundings were received for this study. 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Clinical parameters of 38 Orthopaedic surgeons (N = 38) Surgeon Height (cm) Distance between knees apart (cm) Distance between arms apart (cm) Distance from thoracic region to edge of table (cm) Distance from table to arm of C-arm (cm) Distance from table to transducer or receiver of C-arm (cm) 1 168 40 32 30 88 92 2 172 20 29 28 95 90 3 165 35 30 37 100 88 4 180 50 33 25 85 95 5 175 30 28 32 90 100 6 160 25 27 35 97 87 7 176 45 29 40 93 85 8 169 55 31 22 90 93 9 171 15 30 27 92 89 10 163 32 34 33 88 94 11 178 38 25 28 100 90 12 174 42 30 35 95 87 13 166 33 28 39 85 98 14 170 36 30 31 91 90 15 162 18 26 29 89 88 16 181 48 33 26 102 95 17 167 34 29 28 92 90 18 173 37 30 32 87 100 19 171 45 35 33 93 89 20 164 30 27 25 95 92 21 168 12 29 29 90 91 22 176 60 33 37 88 86 23 169 40 31 28 99 97 24 172 22 30 33 92 95 25 160 35 26 27 90 89 26 178 55 34 40 85 94 27 175 28 32 32 100 90 28 163 42 30 21 96 88 29 170 33 29 29 91 91 30 165 18 28 34 87 102 31 182 52 34 36 93 90 32 168 46 30 30 88 83 33 177 25 31 35 90 99 34 161 38 24 27 98 94 35 174 44 33 33 94 90 36 166 30 27 39 87 100 37 179 56 32 32 92 92 38 170 34 30 31 90 90 Average with SD 170 ± 10 35 ± 15 30 ± 5 30 ± 8 90 ± 10 90 ± 10 Table 1 B. Average radiation exposure for distal radius fracture, distal radio-ulnar fractures, metacarpal fractures (plating and closed reduction with pining or nailing), and forearm two bones fractures Surgical procedures Average duration of radiation exposures (seconds) Distal radius fractures 155 ± 10 Distal radio-ulnar fractures 250 ± 20 Metacarpal fractures (plating) 90 ± 5 Metacarpal fractures (closed reduction with pining or nailing) 80 ± 10 Forearm two bones fractures 330 ± 20 Table 2. Two-piece lead gown (μSv, cumulative) Group 1 - Seated with knees 15 cm apart (C-arm upright) Eye Eye (external) % reduction Thyroid Thyroid (external) % reduction Groin Groin (external) % reduction 1min Average 0.2 0.4 -50.0 0.0 0.4 -100.0 0.0 0.1 -100.0 3mins Average 0.3 1.0 -70.0 0.0 1.1 -100.0 0.0 0.3 -100.0 5mins Average 0.2 2.1 -90.5 0.0 2.3 -100.0 0.0 0.5 -100.0 Group 2 - Seated with knees 15 cm apart (C-arm inverted) Eye Eye (external) % reduction Thyroid Thyroid (external) % reduction Groin Groin (external) % reduction 1min Average 0.4 0.6 -33.3 0.0 0.6 -100.0 0.0 0.4 -100.0 3mins Average 1.3 2.0 -35.0 0.0 2.2 -100.0 0.0 1.1 -100.0 5mins Average 1.7 3.0 -43.3 0.0 3.4 -100.0 0.0 2.3 -100.0 Group 3 - Seated with knees 45 cm apart (C-arm upright) Eye Eye (external) % reduction Thyroid Thyroid (external) % reduction Groin Groin (external) % reduction 1min Average 0.2 0.6 -66.7 0.0 0.7 -100.0 0.0 0.6 -100.0 3mins Average 0.3 0.8 -62.5 0.0 0.9 -100.0 0.0 1.2 -100.0 5mins Average 0.4 2.3 -82.6 0.0 2.5 -100.0 0.0 1.8 -100.0 Table 3. One-piece lead gown (μSv, cumulative) Group 1 – Seated with knees 15 cm apart (C-arm upright) Eye Eye (external) % reduction Thyroid Thyroid (external) % reduction Groin Groin (external) % reduction 1min Average 0.2 0.7 -71.4 0.0 0.6 -100.0 0.0 0.2 -100.0 3mins Average 0.3 2.0 -85.0 0.0 1.9 -100.0 0.0 0.5 -100.0 5mins Average 0.4 3.4 -88.2 0.0 3.6 -100.0 0.0 1.0 -100.0 Group 2 - Seated with knees 15 cm apart (C-arm inverted) Eye Eye (external) % reduction Thyroid Thyroid (external) % reduction Groin Groin (external) % reduction 1min Average 0.7 0.9 -22.2 0.0 1.0 -100.0 0.0 0.9 -100.0 3mins Average 2.2 2.9 -24.1 0.0 3.0 -100.0 0.0 2.2 -100.0 5mins Average 3.8 4.7 -19.1 0.0 4.9 -100.0 0.0 3.5 -100.0 Group 3 - Seated with knees 45 cm apart (C-arm upright) Eye Eye (external) % reduction Thyroid Thyroid (external) % reduction Groin Groin (external) % reduction 1min Average 0.1 0.5 -80.0 0.0 0.6 -100.0 0.0 0.2 -100.0 3mins Average 0.2 1.4 -85.7 0.0 1.9 -100.0 0.0 0.5 -100.0 5mins Average 0.5 2.0 -75.0 0.0 3.1 -100.0 0.0 0.8 -100.0 Table 4. ANOVA and Cohen’s d analysis between gown types and body positions for radiographic exposure to eyes Dependent variable Factor / Comparison df F p-value Effect size Internal dose Gown type 1,14 1.28 0.276 η² = 0.041 (small) Position (upright / inverted / wide) 2,14 7.93 0.005* η² = 0.509 (large) External dose Gown type 1,14 1.34 0.266 η² = 0.074 (small) Position (upright / inverted / wide) 2,14 1.37 0.286 η² = 0.152 (small–moderate) Internal dose Upright vs Inverted C-arm 1,16 16.59 0.0009* Cohen’s d = − 2.04 (very large) External dose Upright vs Inverted C-arm 1,16 2.56 0.129 Cohen’s d = − 0.80 (large, NS) *p < 0.05 considered statistically significant. η² = eta squared (proportion of variance explained) Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 13 Apr, 2026 Reviews received at journal 13 Mar, 2026 Reviews received at journal 06 Mar, 2026 Reviewers agreed at journal 03 Mar, 2026 Reviewers agreed at journal 02 Mar, 2026 Reviewers agreed at journal 26 Feb, 2026 Reviews received at journal 26 Feb, 2026 Reviewers agreed at journal 25 Feb, 2026 Reviews received at journal 20 Feb, 2026 Reviewers agreed at journal 20 Feb, 2026 Reviewers agreed at journal 20 Feb, 2026 Reviewers invited by journal 18 Feb, 2026 Editor assigned by journal 16 Feb, 2026 Editor invited by journal 27 Jan, 2026 Submission checks completed at journal 23 Jan, 2026 First submitted to journal 23 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8660309","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":593896815,"identity":"4a57bfb0-4422-44f9-8ac0-1d5021701f85","order_by":0,"name":"Kai-Xing Alvin Lee","email":"","orcid":"","institution":"China Medical University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kai-Xing","middleName":"Alvin","lastName":"Lee","suffix":""},{"id":593896819,"identity":"06f9c6bd-fa1d-4645-be1c-5624350e8181","order_by":1,"name":"Hao-Wei Chang","email":"","orcid":"","institution":"China Medical University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hao-Wei","middleName":"","lastName":"Chang","suffix":""},{"id":593896821,"identity":"22a04df3-74e2-4dbd-94e3-f1b46828becb","order_by":2,"name":"Chin-Jung Hsu","email":"","orcid":"","institution":"China Medical University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chin-Jung","middleName":"","lastName":"Hsu","suffix":""},{"id":593896822,"identity":"32a4b621-22a1-42fb-be24-99926772fa22","order_by":3,"name":"Chun-Hao Tsai","email":"","orcid":"","institution":"China Medical University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chun-Hao","middleName":"","lastName":"Tsai","suffix":""},{"id":593896823,"identity":"d424837a-0452-4199-a312-a308f90cc688","order_by":4,"name":"Hsien-Te Chen","email":"","orcid":"","institution":"China Medical University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hsien-Te","middleName":"","lastName":"Chen","suffix":""},{"id":593896824,"identity":"61876e10-629d-42d2-b2f6-a9569ed49d8e","order_by":5,"name":"Cheng-Di Chiu","email":"","orcid":"","institution":"China Medical University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Cheng-Di","middleName":"","lastName":"Chiu","suffix":""},{"id":593896825,"identity":"11d5d183-b714-4b13-b065-54f0846f91e1","order_by":6,"name":"Shih-Han Lee","email":"","orcid":"","institution":"He-Shi Orthopaedic Clinic","correspondingAuthor":false,"prefix":"","firstName":"Shih-Han","middleName":"","lastName":"Lee","suffix":""},{"id":593896826,"identity":"3437534d-af94-4aed-bd8c-3dbce68f36eb","order_by":7,"name":"Chia-Yu Lin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYDACCcYGIGnBw8DMfODghwogm5m5gRgtEjwM7GyJhyXOgLQwEtICI/l5jA/wtoE4BLTwz25u/MzbJiFjzsxgcEByXm00fztQy4+KbbgtuXOwWRqohceymSHhQOG247kzDjM2MPacuY1Ti4FEYgNYi8FhhgMHJLcdy20AamFmbMOrpfk3RAtjwwHeOcdy5xOhpQ1qCzPDAd6GmtwNhLRI3Ehss5xzDqSFjeGwxLEDuRuBWg7i8wv/jPTHN96U2dgbnD//+eOHmrrceecPH3zwowK3FhBg4kGwD4PJA3jVAwHjDwS7jpDiUTAKRsEoGIEAAFyOWyCcRGjxAAAAAElFTkSuQmCC","orcid":"","institution":"China Medical University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Chia-Yu","middleName":"","lastName":"Lin","suffix":""}],"badges":[],"createdAt":"2026-01-21 13:24:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8660309/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8660309/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103178739,"identity":"7ddafb2d-2fe5-4d77-b8df-75e9ed7c3db9","added_by":"auto","created_at":"2026-02-22 17:06:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":143695,"visible":true,"origin":"","legend":"\u003cp\u003eHeight versus knee distance of 38 Orthopaedic surgeons from our department\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8660309/v1/20fad269a4d2f3eb2b41d11b.png"},{"id":103178738,"identity":"33fb5faa-fd80-403e-a3f7-3b441e60bbe7","added_by":"auto","created_at":"2026-02-22 17:06:25","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1180254,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Diagram depicting the locations of the external dosimeters (eye, thyroid and groin); (B) Seated position with knees 45 cm apart and arms 30 cm apart; (C) Lateral view with inverted C-arm with the distances of operator to C-arm as detailed in the figure\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8660309/v1/fd4a4d6d2878bb3be24f358e.png"},{"id":107479665,"identity":"441b4d9f-a541-4283-8703-b1b2b00b91db","added_by":"auto","created_at":"2026-04-22 01:42:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2265039,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8660309/v1/74b9d920-89cc-459a-b76e-6868f502b019.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eRadiation Exposure to the Thyroid, Groin and Eyes in Seated Orthopaedic Surgeries with Real-Time Clinical Correlations\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eFluoroscopic imaging is indispensable in orthopaedic trauma surgery, and it exposes surgeons and operating room staff to ionizing radiation. Both primary and scatter radiation can pose occupational hazards, with cumulative exposure linked to cataracts, infertility, and malignancy [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Evidence from the Atomic Bomb Survivors Life-Span Study, which followed 50,000 survivors within 3 km of the Hiroshima and Nagasaki epicenters, highlighted the long-term health effects of radiation doses\u0026thinsp;\u0026ge;\u0026thinsp;500 mSv [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In response, the International Commission on Radiological Protection (ICRP) has progressively tightened occupational dose limits, most notably reducing the annual lens threshold from 150 to 20 mSv to address cataract risk, while maintaining a 500 mSv annual limit for skin exposure [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo mitigate intraoperative risks, protective gowns such as lead gowns, thyroid collars, and lead glasses are recommended, alongside institutional safeguards including regular equipment checks and staff dosimetry [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Nonetheless, scatter radiation from the C-arm remains a major source of exposure during procedures, and several factors influence dose magnitude\u0026mdash;particularly gown design, C-arm orientation, and surgeon positioning [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Prior studies suggest that gown skirts may separate during seated procedures, potentially compromising gonadal protection, and that inverted C-arm positioning can redirect scatter upward toward the surgeon\u0026rsquo;s head and eyes [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. These scenarios are particularly common in orthopaedic trauma surgery. When operating on the hand or other small joints, surgeons often adopt a seated position to enhance manual stability during delicate procedures. As a result, prolonged seated operation and challenging fluoroscopic angles are frequently encountered in clinical practice [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite these risks, there is limited evidence quantifying how different gown designs and seated positions under varying C-arm orientations affect radiation exposure.\u003c/p\u003e \u003cp\u003eUnderstanding these dynamics is critical to refining occupational safety protocols. There are currently several isolated studies examining regarding radiation exposure and cataract risks, testicular and thyroid exposures [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, more studies are required to value-add to these results by examining for various realistic situations. Our study was the first to correlate clinical parameters, including height, distance between knees apart, distance between arms apart, distance from thoracic region to edge of table, distance from table to arm of C-arm and distance from table to transducer or receiver of C-arm. We collated real-time duration of radiation exposure for several common seated surgical procedures and the clinical parameters and datas were incorporated into our study design. In addition, we conducted a simple interview of all of our Orthopaedic surgeons and the three main worries were radiation exposure risks between gown designs, inverted C-arm exposures and radiation exposure to the gonadal region during seated positions. Therefore, this study aimed to measure scatter radiation under two gown designs (two-piece skirt-vest vs. one-piece cross-back) across multiple seated positions, including upright and inverted C-arm use. Internal (beneath the gown) and external (outside the gown) doses were recorded at the eye, thyroid, and groin over 1-, 3-, and 5-minute fluoroscopy intervals. Our primary objective was to assess protective efficiency and clarify whether seated posture and C-arm orientation outweigh gown design in determining exposure risk. The secondary objective was to assess if inverted and upright C-arm positions had a role to play in radiation exposure to the eyes.\u003c/p\u003e \u003cp\u003eUnlike prior phantom or dosimetry studies that rely on standardized or idealized operator positioning, the present study was specifically designed to replicate real-time clinical operating conditions. Surgeon-specific measurements\u0026mdash;including seated posture, knee separation, arm position, and C-arm geometry\u0026mdash;were incorporated directly into the experimental setup based on observed intraoperative practice. To our knowledge, this is the first study to correlate scatter radiation exposure with clinically derived, real-world surgeon positioning during seated orthopaedic procedures, thereby bridging the gap between experimental dosimetry and operative reality.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eRadiation exposure experiments were performed using a standardized C-arm orthopaedic fluoroscopy setup (Siemens Cios Flow.neo; USA; 46 kVp, 0.61 mA). Dosimeters (Raysafe i3; Sweden) were positioned at the eye, thyroid, and groin levels to capture scatter dose in two conditions: external (outside the gown) and internal (beneath the gown) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). A total of 6 portable dosimeters were thus placed on the mannequin. Calibration is conducted according to manufacturer\u0026rsquo;s instructions prior to our evaluation. The detection limit of the dosimeter is \u0026lt;\u0026thinsp;30 microsieverts (\u0026micro;Sv).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn this study, we collated clinical parameters of 38 Orthopaedic surgeons from our hospital when utilizing C-arm and operating under seated conditions, including height, distance between knees apart, distance between arms apart, distance from thoracic region to edge of table, distance from table to arm of C-arm and distance from table to transducer or receiver of C-arm. These results were as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003eA and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A seated full-sized mannequin (170 cm was chosen) was used to simulate the orthopaedic surgeon operating on a radiolucent surgical arm table (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). Importantly, all positional parameters used in this study\u0026mdash;including knee separation, arm spacing, torso-to-table distance, and C-arm alignment\u0026mdash;were derived from direct measurements of practicing orthopaedic surgeons during routine seated procedures, ensuring close correlation with real-time clinical workflow rather than theoretical positioning.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe dimensions of the torso corresponded to medium-sized protective lead gowns according to the manufacturer\u0026rsquo;s sizing chart. Two protective gown designs were evaluated: a two-piece lead skirt-vest and a one-piece cross-back gown. Both protective lead gowns were commercially available products commonly used in clinical practice.\u003c/p\u003e \u003cp\u003eThe two-piece skirt\u0026ndash;vest apron and the one-piece cross-back apron were manufactured with a nominal lead equivalence of 0.5 mm Pb at 80 kVp, consistent with standard occupational radiation protection requirements. Lead glasses were worn by the mannequin in all experimental conditions. The lead glasses had a nominal lead equivalence of 0.5 mm Pb and were kept constant throughout all measurements. Therefore, differences in radiation exposure observed in this study were not attributable to disparities in lead thickness but rather to gown configuration, surgeon posture, and C-arm orientation.\u003c/p\u003e \u003cp\u003eThree body positions were tested under fluoroscopy:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eGroup 1 and 2 \u0026mdash; Seated with knees 15 cm apart (C-arm upright and inverted) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003eC).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eGroup 3 \u0026mdash; Seated with knees 45 cm apart (C-arm upright) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003eB).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eFor all positions, the back and hip of the mannequin was erected seated in-line with the back support of the surgical chair. The surgical arm table was placed 30 cm from the thoracic region of the mannequin and the arms were placed 30 cm apart (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). The distance from the thoracic to edge of table was 30 cm, distance from edge of table to arm of C-arm was 90 cm and distance from table to transducer or receiver of C-arm was 90 cm (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003eC).\u003c/p\u003e \u003cp\u003eIn addition, we collated the average total fluroscopy exposure for various types of seated surgical procedures including distal radius fracture, distal radio-ulnar fractures, metacarpal fractures (plating and closed reduction with pining or nailing), and forearm two bones fractures (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). A total of 10 surgical procedures each were collated for this study. Using this data as a guide, fluoroscopy was activated continuously for 1, 3, and 5 minutes in this study. Five tests were done for each group with the averages recorded. Doses were recorded in \u0026micro;Sv.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eDescriptive statistics (mean values across 1, 3, and 5 minutes) were reported for each condition. Percentage reduction was calculated as Percentage of Reduction = [(External\u0026minus;Internal​)/ External] \u0026times; 100%. Differences between gown types (two-piece vs. one-piece) and experimental positions (upright, inverted, wide stance) were evaluated using two-way analysis of variance (ANOVA) without replication, stratified by anatomical site. For the eyes, effect sizes (η\u0026sup2;, eta squared) were calculated to quantify the proportion of variance explained by each factor. Cohen\u0026rsquo;s conventions were used (η\u0026sup2; = 0.01 small, 0.06 medium, 0.14 large).\u003c/p\u003e \u003cp\u003eTo specifically examine the effect of C-arm orientation, eye doses were regrouped into Upright (upright\u0026thinsp;+\u0026thinsp;wide stance) and Inverted conditions. One-way ANOVA was used to compare these two orientations, with Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e reported as a standardized effect size (0.2 small, 0.5 medium, 0.8 large). A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. All analyses were performed in SPSS (Version 20).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe cumulative exposure for two-piece lead gowns (3 groups with eye, thyroid and groin) and one-piece lead gown (3 groups with eye, thyroid and groin) were as shown in Tables\u0026nbsp;2 and 3 respectively. The ANOVA and Cohen\u0026rsquo;s d analysis between gown types and body positions for eyes were as shown in Table\u0026nbsp;4. The results were displayed as per anatomical part below.\u003c/p\u003e \u003cp\u003eEye exposure\u003c/p\u003e \u003cp\u003eIn the one-piece gown group, internal eye doses reached 0.1\u0026ndash;3.8 \u0026micro;Sv, while external ranged 0.5\u0026ndash;4.7 \u0026micro;Sv, giving reductions of 19% to 89%. In the two-piece gown, eye doses ranged from 0.2 \u0026micro;Sv (1 min, upright) to 1.7 \u0026micro;Sv (5 min, inverted) internally, compared with 0.4\u0026ndash;3.0 \u0026micro;Sv externally, corresponding to reductions of 33% to 91%. Two-way ANOVA for eye exposure showed that position (upright, inverted, seated 45 cm knees apart) had a significant effect on internal doses (F(2,14)\u0026thinsp;=\u0026thinsp;7.93, p\u0026thinsp;=\u0026thinsp;0.005, η\u0026sup2; = 0.51), indicating that body stance and C-arm orientation accounted for more than half of the variance. In contrast, gown type (two-piece vs. one-piece) did not significantly influence internal eye dose (F(1,14)\u0026thinsp;=\u0026thinsp;1.28, p\u0026thinsp;=\u0026thinsp;0.276, η\u0026sup2; = 0.04). For external eye exposure, neither gown type (F(1,14)\u0026thinsp;=\u0026thinsp;1.34, p\u0026thinsp;=\u0026thinsp;0.266, η\u0026sup2; = 0.07) nor position (F(2,14)\u0026thinsp;=\u0026thinsp;1.37, p\u0026thinsp;=\u0026thinsp;0.286, η\u0026sup2; = 0.15) reached statistical significance, although effect sizes suggested small to moderate contributions. Our team hypothesized that C-arm orientation has a role to play in eye exposure. The inverted C-arm in both groups had the highest exposure due to proximity of the X-ray source and scatter radiation to the eyes. In addition, lead glasses provided lower protection for the inverted C-arm group (19.1% to 43.3%) as compared to the upright group (50% to 90.5%). When regrouped by C-arm orientation, internal eye dose was significantly higher in the inverted position compared with upright (F(1,16)\u0026thinsp;=\u0026thinsp;16.59, p\u0026thinsp;=\u0026thinsp;0.0009, Cohen\u0026rsquo;s d = \u0026minus;\u0026thinsp;2.04, very large effect). External doses trended higher in the inverted orientation as well, but this difference was not statistically significant (F(1,16)\u0026thinsp;=\u0026thinsp;2.56, p\u0026thinsp;=\u0026thinsp;0.129, Cohen\u0026rsquo;s d = \u0026minus;\u0026thinsp;0.80, large effect).\u003c/p\u003e \u003cp\u003eThyroid exposure\u003c/p\u003e \u003cp\u003eInternal thyroid doses were consistently below minimum detectability of dosimeter in both gown types across all conditions, while external readings ranged from 0.4\u0026ndash;3.4 \u0026micro;Sv, reflecting approximately full protection.\u003c/p\u003e \u003cp\u003eGroin exposure\u003c/p\u003e \u003cp\u003eWith the two-piece gown, internal groin doses were below minimum detectability of dosimeter, whereas external ranged 0.1\u0026ndash;2.3 \u0026micro;Sv, yielding approximately full protection. With the one-piece gown, groin internal values remained below minimum detectability of dosimeter, with external up to 3.5 \u0026micro;Sv, also showing approximately full protection.\u003c/p\u003e \u003cp\u003eBecause the experimental configuration reflected clinically measured surgeon posture and fluoroscopic setup, the observed dose differences directly reflect real-world intraoperative exposure patterns rather than abstract dosimetric models.\u003c/p\u003e"},{"header":"Discussions","content":"\u003cp\u003eThis study evaluated scatter radiation exposure at the eye, thyroid, and groin using a mannequin model under different protective gown designs and C-arm orientations. The results highlight the relative strengths of protective gowns and the dominant role of operator positioning in determining dose distribution. Our study proved that both types of protective gowns are effective in provention of intraoperative scatter radiation to thyroid and groin region. Furthermore, the protection was effective regardless of seated knees in narrow (15 cm) or wide (45 cm) positions. It was initially hypothesized that sitting with the one-piece protective gown might expose the groin region to radiation due to splitting of the one-piece design, especially so for the knees wide apart position. Both types of protective gowns significently reduced radiation exposure to below detection limit of dosimeter. A key strength of this study lies in its direct correlation with real-time clinical practice. Previous investigations have often assessed radiation exposure under fixed or idealized conditions, without accounting for surgeon-specific posture or seated operating geometry. In contrast, our study incorporated measured intraoperative parameters from practicing orthopaedic surgeons, allowing scatter radiation patterns to be evaluated in a manner that closely reflects day-to-day operative conditions. This approach enhances the clinical validity of our findings and may explain the large effect sizes observed with changes in C-arm orientation.\u003c/p\u003e \u003cp\u003eThe eye remained the most vulnerable site despite protective glasses, with detectable internal doses across all conditions. Two-way ANOVA confirmed that position significantly influenced internal eye dose (F(2,14)\u0026thinsp;=\u0026thinsp;7.93, p\u0026thinsp;=\u0026thinsp;0.005, η\u0026sup2;=0.51, large effect), while gown type did not. When regrouped by C-arm orientation, inverted positioning produced substantially higher internal doses than upright (F(1,16)\u0026thinsp;=\u0026thinsp;16.59, p\u0026thinsp;=\u0026thinsp;0.0009; Cohen\u0026rsquo;s d=\u0026ndash;2.04, very large effect). External doses trended higher in the inverted orientation as well, though this did not reach significance. These findings suggest that scatter directed upward in inverted geometry increases ocular exposure, overwhelming the modest differences between the groups. Reported protection efficiencies were lowest in the inverted group (19\u0026ndash;43%) compared with upright (50\u0026ndash;91%), underscoring the importance of avoiding inverted C-arm use whenever feasible and reinforcing the value of adjunct eye shielding such as lead glasses. There are increased evidences and publications showing that low-dose, long-term radiation exposure leads to cataract formation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Interventional radiologists and cardiologists exposed to chronic scatter show higher rates of lens opacities compared with unexposed groups, with prevalence estimates up to 16\u0026ndash;17% in some cohorts [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Epidemiological reviews suggest that the threshold for radiation-induced cataracts may be far lower than previously assumed, prompting the ICRP to reduce the annual occupational limit for the lens to 20 mSv [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Recent dosimetry studies confirm that orientation and positioning of the C-arm strongly influence lens dose, and that protective eyewear significantly mitigates, but does not eliminate risk [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Although lead glasses were used in all experimental conditions, internal eye dose remained strongly dependent on C-arm orientation. This finding suggests that while lead eyewear provides baseline protection, it cannot fully mitigate the increased scatter radiation directed toward the eyes during inverted C-arm positioning.\u003c/p\u003e \u003cp\u003eIn contrast, the neck collar provided complete attenuation, with internal doses consistently undetectable (below detectable limits) under both gown types across all positions and timepoints. External thyroid values increased with time but did not translate to internal exposure, demonstrating the effectiveness of neck collars and gown overlap when correctly positioned. These findings support existing guidelines that mandate routine thyroid collar use in all fluoroscopic procedures [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Similarly, groin protection for both two-piece and one-piece gowns were effective, with all internal readings below the detection threshold. These results reaffirm the importance of protective gowns, regardless of designs, and show that, when fitted correctly, both designs provide equivalent protection at the gonads. Occupational radiation to the testicular region has been highlighted as an underappreciated risk among orthopaedic surgeons [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Phantom studies simulating operative positions demonstrated that gown type and seating posture influence scatter reaching the gonads, with gaps in lead skirt coverage during seated procedures leading to increased testicular exposure. Clinical observations also suggest possible downstream effects: a nationwide survey of Japanese doctors reported a higher female-to-male offspring ratio among orthopaedic surgeons chronically exposed to fluoroscopy, raising concerns about gonadal radiation effects on fertility [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Although diagnostic imaging studies confirm that direct shielding can markedly reduce testicular dose during CT examinations, real-world surgical data remain limited, and published evidence emphasizes the importance of secure gown overlap, particularly when the surgeon is seated for prolonged procedures. Our studies further showed that all gown types are suitable for protection, regardless of knee positioning.\u003c/p\u003e \u003cp\u003eOur study was not without limitations. This study was conducted in a simulated mannequin model without patient variability, body habitus differences, or dynamic operator movement. Doses were measured at fixed locations and averaged across short exposures (1\u0026ndash;5 minutes). While these conditions allow controlled comparisons, real surgical scenarios may involve higher variability. Furthermore, as our dosimeter had a detection limit of 30 \u0026micro;Sv, therefore any ionizing radiation below this limit were not recorded. In addition, our study was conducted with the mannequin seated in static position, which might not be realistic in real-world model. Even with ICRP and local institutions emphasis on radiations safety, a survey in 2021 showed that orthopaedic surgeons were still unclear regarding radiation safety, C-arm usage and radiation principles. From our results, we strongly advocate to prioritize upright C-arm orientation whenever clinically possible, minimize wide stance and inverted positioning, standardize use of thyroid collars and lead skirts, and to adopt lead glasses as routine adjunct protection. To our knowledge, this is the first investigation to integrate gown design, seated surgeon posture, and C-arm orientation using clinically derived measurements to assess radiation exposure at the eye, thyroid, and groin. By aligning experimental design with real-time practice, our findings provide actionable insights that can be immediately translated into operative behavior and institutional radiation safety policies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eProtective lead gowns provide complete shielding at the thyroid and groin, but ocular exposure remains position-dependent. Although this study was performed using a standardized mannequin model, the findings provide several clinically relevant insights. Inverted C-arm positioning should be avoided when feasible, as it was consistently associated with higher internal ocular exposure. Routine use of lead glasses remains advisable given that measurable eye doses occurred under all conditions. In contrast, the thyroid collar and lead gowns reliably reduced thyroid and groin exposure to below the detection threshold, and both one-piece and two-piece designs offered comparable protection.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical review and Consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This study did not involve human participants or patient-related data. The experimental protocol used a mannequin model only. Surgeon-related clinical parameters were recorded in a de-identified manner and contained no personally identifiable information; therefore, informed consent and ethical approval was waived by China Medical University Hospital Institutional Review Board.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInformed consent for 1 participant was obtained for the representative image in the Figure section.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEach author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKai-Xing, Alvin Lee and Hao-Wei Chang conceptualized the study design and drafted the article. Chin-Jung Hsu, Chun-Hao Tsai were in-charge of compiling and tabulating data. Cheng-Di Chiu and Shih-Han Lee were involved in managing logistical arrangements. Hsien-Te Chen and Chia-Yu Lin were the attending surgeon in charge and Chia-Yu Lin was the corresponding author. The authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated in this study are included in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo fundings were received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHayda RA, Hsu RY, Mason DePasse J, Gil JA. 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Clinical parameters of 38 Orthopaedic surgeons (N\u0026thinsp;=\u0026thinsp;38)\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSurgeon\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eHeight (cm)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDistance between knees apart (cm)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDistance between arms apart (cm)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDistance from thoracic region to edge of table (cm)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDistance from table to arm of C-arm (cm)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDistance from table to transducer or receiver of C-arm (cm)\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e168\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e40\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e32\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e88\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e92\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e172\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e20\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e29\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e28\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e95\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e165\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e35\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e37\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e100\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e88\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e180\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e50\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e33\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e25\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e85\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e95\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e175\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e28\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e32\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e100\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e160\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e25\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e27\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e35\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e97\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e87\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e176\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e45\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e29\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e40\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e93\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e85\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e8\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e169\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e55\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e31\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e22\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e93\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e9\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e171\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e15\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e27\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e92\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e89\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e163\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e32\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e34\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e33\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e88\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e94\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e11\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e178\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e38\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e25\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e28\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e100\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e174\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e42\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e35\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e95\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e87\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e13\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e166\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e33\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e28\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e39\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e85\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e98\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e14\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e170\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e36\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e31\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e91\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e15\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e162\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e18\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e26\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e29\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e89\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e88\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e16\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e181\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e48\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e33\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e26\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e102\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e95\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e17\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e167\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e34\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e29\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e28\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e92\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e18\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e173\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e37\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e32\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e87\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e100\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e19\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e171\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e45\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e35\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e33\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e93\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e89\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e20\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e164\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e27\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e25\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e95\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e92\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e21\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e168\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e29\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e29\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e91\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e22\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e176\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e60\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e33\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e37\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e88\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e86\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e23\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e169\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e40\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e31\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e28\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e99\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e97\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e24\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e172\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e22\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e33\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e92\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e95\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e25\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e160\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e35\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e26\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e27\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e89\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e26\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e178\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e55\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e34\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e40\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e85\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e94\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e27\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e175\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e28\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e32\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e32\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e100\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e28\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e163\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e42\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e21\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e96\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e88\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e29\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e170\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e33\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e29\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e29\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e91\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e91\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e165\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e18\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e28\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e34\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e87\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e102\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e31\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e182\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e52\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e34\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e36\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e93\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e32\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e168\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e46\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e88\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e83\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e33\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e177\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e25\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e31\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e35\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e99\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e34\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e161\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e38\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e24\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e27\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e98\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e94\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e35\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e174\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e44\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e33\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e33\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e94\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e36\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e166\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e27\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e39\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e87\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e100\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e37\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e179\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e56\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e32\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e32\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e92\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e92\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e38\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e170\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e34\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e31\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAverage with SD\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e170\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e35\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u0026thinsp;\u0026plusmn;\u0026thinsp;8\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eB. Average radiation exposure for distal radius fracture, distal radio-ulnar fractures, metacarpal fractures (plating and closed reduction with pining or nailing), and forearm two bones fractures\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSurgical procedures\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAverage duration of radiation exposures (seconds)\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDistal radius fractures\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e155\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDistal radio-ulnar fractures\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e250\u0026thinsp;\u0026plusmn;\u0026thinsp;20\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMetacarpal fractures (plating)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMetacarpal fractures (closed reduction with pining or nailing)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e80\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eForearm two bones fractures\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e330\u0026thinsp;\u0026plusmn;\u0026thinsp;20\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u003cstrong\u003eTable 2. \u003c/strong\u003eTwo-piece lead gown (\u0026mu;Sv, cumulative)\u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroup 1 - Seated with knees 15 cm apart (C-arm upright)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eEye\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eEye (external)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e% reduction\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eThyroid\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eThyroid (external)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e% reduction\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroin\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroin (external)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e% reduction\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1min Average\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-50.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.1\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3mins Average\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.3\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-70.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.1\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.3\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5mins Average\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.1\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-90.5\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.3\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.5\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroup 2 - Seated with knees 15 cm apart (C-arm inverted)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eEye\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eEye (external)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e% reduction\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eThyroid\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eThyroid (external)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e% reduction\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroin\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroin (external)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e% reduction\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1min Average\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.6\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-33.3\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.6\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3mins Average\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.3\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-35.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.1\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5mins Average\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.7\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-43.3\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.3\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroup 3 - Seated with knees 45 cm apart (C-arm upright)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eEye\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eEye (external)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e% reduction\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eThyroid\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eThyroid (external)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e% reduction\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroin\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroin (external)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e% reduction\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1min Average\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.6\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-66.7\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.7\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.6\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3mins Average\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.3\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.8\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-62.5\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.9\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5mins Average\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.3\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-82.6\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.5\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.8\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u003cbr\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e One-piece lead gown (\u0026mu;Sv, cumulative)\u003cbr\u003e\n \u003ctable id=\"Tabb\" border=\"1\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroup 1 \u0026ndash; Seated with knees 15 cm apart (C-arm upright)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eEye\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eEye (external)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e% reduction\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eThyroid\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eThyroid (external)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e% reduction\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroin\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroin (external)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e% reduction\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1min Average\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.7\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-71.4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.6\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3mins Average\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.3\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-85.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.9\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.5\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5mins Average\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-88.2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.6\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroup 2 - Seated with knees 15 cm apart (C-arm inverted)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eEye\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eEye (external)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e% reduction\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eThyroid\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eThyroid (external)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e% reduction\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroin\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroin (external)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e% reduction\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1min Average\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.7\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.9\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-22.2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.9\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3mins Average\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.9\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-24.1\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5mins Average\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.8\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4.7\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-19.1\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4.9\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.5\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroup 3 - Seated with knees 45 cm apart (C-arm upright)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eEye\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eEye (external)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e% reduction\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eThyroid\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eThyroid (external)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e% reduction\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroin\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGroin (external)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e% reduction\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1min Average\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.1\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.5\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-80.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.6\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3mins Average\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-85.7\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.9\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.5\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5mins Average\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.5\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-75.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.1\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.8\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-100.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003eTable 4. ANOVA and Cohen\u0026rsquo;s d analysis between gown types and body positions for radiographic exposure to eyes\u003c/div\u003e\n \u003ctable id=\"Tabc\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDependent variable\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFactor / Comparison\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003edf\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eF\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ep-value\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eEffect size\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eInternal dose\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGown type\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1,14\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.28\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.276\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026eta;\u0026sup2; = 0.041 (small)\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePosition (upright / inverted / wide)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2,14\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7.93\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.005*\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026eta;\u0026sup2; = 0.509 (large)\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eExternal dose\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGown type\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1,14\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.34\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.266\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026eta;\u0026sup2; = 0.074 (small)\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePosition (upright / inverted / wide)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2,14\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.37\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.286\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026eta;\u0026sup2; = 0.152 (small\u0026ndash;moderate)\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eInternal dose\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eUpright vs Inverted C-arm\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1,16\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e16.59\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.0009*\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCohen\u0026rsquo;s \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003ed\u003c/span\u003e = \u0026minus;\u0026thinsp;2.04 (very large)\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eExternal dose\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eUpright vs Inverted C-arm\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1,16\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.56\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.129\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCohen\u0026rsquo;s \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003ed\u003c/span\u003e = \u0026minus;\u0026thinsp;0.80 (large, NS)\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered statistically significant.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e\u0026eta;\u0026sup2; = eta squared (proportion of variance explained)\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmim","sideBox":"Learn more about [BMC Medical Imaging](http://bmcmedimaging.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmim/default.aspx","title":"BMC Medical Imaging","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Orthopaedic surgery, Scatter radiation, Lead gown protection, C-arm fluoroscopy, Occupational exposure","lastPublishedDoi":"10.21203/rs.3.rs-8660309/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8660309/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eFluoroscopic imaging is indispensable in orthopaedic surgery but exposes surgeons to scatter radiation. Protective lead gowns reduce exposure, but differences in gown design, C-arm orientation, and seated positioning may influence protection efficiency at critical anatomical sites. Eye exposure is of particular concern due to the revised occupational dose limit of 20 mSv/year by the International Commission on Radiological Protection (ICRP). This study aimed to quantify scatter radiation exposure at the eye, thyroid, and groin under different gown configurations and positions during seated fluoroscopy. Our study was the first study to incorporate clinical parameters and settings into our study design.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eRadiation exposure experiments were performed using a standardized C-arm fluoroscopy setup (46 kVp, 0.61 mA) with a full-sized mannequin seated at an orthopaedic surgical arm table. Raysafe i3 dosimeters were placed externally (outside gown) and internally (beneath gown) at the eye, thyroid, and groin. Two protective gowns were tested: a two-piece skirt\u0026ndash;vest and a one-piece cross-back gown. Three seated positions were evaluated: (i) upright with knees 15 cm apart, (ii) inverted C-arm with knees 15 cm apart, and (iii) upright with knees 45 cm apart. Continuous fluoroscopy was applied for 1, 3, and 5 minutes. Mean values were analyzed using two-way ANOVA (gown \u0026times; position) and regrouped for upright versus inverted C-arm comparisons, with effect sizes (η\u0026sup2;, Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e) calculated.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eInternal eye doses ranged from 0.1\u0026ndash;3.8 \u0026micro;Sv with the one-piece gown and 0.2\u0026ndash;1.7 \u0026micro;Sv with the two-piece gown, corresponding to 19\u0026ndash;91% reductions compared to external measurements. Two-way ANOVA showed that position significantly affected internal eye dose (F(2,14)\u0026thinsp;=\u0026thinsp;7.93, p\u0026thinsp;=\u0026thinsp;0.005, η\u0026sup2; = 0.51, large), while gown type had no significant effect (F(1,14)\u0026thinsp;=\u0026thinsp;1.28, p\u0026thinsp;=\u0026thinsp;0.276). External eye doses were not significantly influenced by either factor. When regrouped by C-arm orientation, inverted positioning produced significantly higher internal eye doses (F(1,16)\u0026thinsp;=\u0026thinsp;16.59, p\u0026thinsp;=\u0026thinsp;0.0009, Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e = \u0026minus;\u0026thinsp;2.04, very large). External doses trended higher in inverted orientation but were not statistically significant (F(1,16)\u0026thinsp;=\u0026thinsp;2.56, p\u0026thinsp;=\u0026thinsp;0.129, \u003cem\u003ed\u003c/em\u003e = \u0026minus;\u0026thinsp;0.80). Internal thyroid and groin exposures were consistently 0 \u0026micro;Sv across all conditions, corresponding to complete protection, while external values increased with time and position.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eProtective lead gowns provided complete shielding at the thyroid and groin, but ocular exposure remained strongly dependent on C-arm orientation and body positioning. The inverted C-arm significantly increased ocular dose despite gown use, underscoring the vulnerability of the lens to scatter radiation. Gown design alone did not significantly alter protection to the eyes. These findings support strict adherence to upright C-arm orientation whenever feasible, routine thyroid collar use, and adoption of lead glasses to further reduce ocular risk. Optimizing fluoroscopic setup and reinforcing protective practices remain essential to minimizing occupational radiation hazards in orthopaedic surgery. This study is the first to evaluate scatter radiation exposure using clinically measured, real-time surgeon positioning during seated orthopaedic fluoroscopy.\u003c/p\u003e","manuscriptTitle":"Radiation Exposure to the Thyroid, Groin and Eyes in Seated Orthopaedic Surgeries with Real-Time Clinical Correlations","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-22 17:06:15","doi":"10.21203/rs.3.rs-8660309/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-14T03:54:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-13T12:47:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-06T14:38:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"142745886539954847514358243365721068440","date":"2026-03-04T04:35:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"10859363173905199020490001989987219818","date":"2026-03-02T13:47:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"310488588801313508687534535973804757410","date":"2026-02-26T10:25:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-26T08:10:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"55443067395369921125798145107084280435","date":"2026-02-25T19:13:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-20T19:39:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"8301747068028098883747326776302242572","date":"2026-02-20T13:46:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"128737186526871255985409673587051268358","date":"2026-02-20T13:17:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-18T12:46:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-16T13:06:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-27T10:30:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-24T02:54:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Imaging","date":"2026-01-24T02:46:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmim","sideBox":"Learn more about [BMC Medical Imaging](http://bmcmedimaging.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmim/default.aspx","title":"BMC Medical Imaging","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7528a307-03ba-4279-a8e5-51175a403ecf","owner":[],"postedDate":"February 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-28T13:38:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-22 17:06:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8660309","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8660309","identity":"rs-8660309","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}