Radiation Exposure and Fluoroscopy Factors which increase radiation exposure levels during use of fluoroscopy standing closer to the c-arm emitter imaging large body parts positioning extremity closer to the x-ray source use of large c-arm rather than mini c-arm radiation exposure is minimal during routine use of mini-c-arm fluoroscopy unless the surgical team is in the direct path of the radiation beam Factors to decrease radiation exposure to patient and surgeon maximizing the distance between the surgeon and the radiation beam minimizing exposure time manipulating the x-ray beam with collimation orienting the fluoroscopic beam in an inverted position relative to the patient strategic positioning of the surgeon within the operative field to avoid direct path of beam use of protective shielding during imaging Orthopaedic surgeons are at elevated risk of breast cancer Upper outer quadrant of breast most common site of breast cancer Lead sleeves and axillary supplements reduce radiation to the breast Risk of Transmission Risk of HIV transmission needlestick seroconversion from a contaminated needlestick is ~ 0.3% exposure to large quantities of blood increases risk seroconversion from exposure to HIV contaminated mucous membranes is ~0.09% frozen bone allograft risk of transmission is <1 per million donor screening is the most important factor in prevention no reported cases of transmission from frozen bone allograft since 2001 blood transfusion risk of transmission from blood transfusion is 1/500,000 per unit transfused seronegative blood may still transmit virus due to delay between HIV infection and antibody development Risk of Hepatitis B transmission needlestick 37% to 62% eventually seroconvert following needlestick 22 to 31% develop clinical Hepatitis B infection following needlestick Risk of Hepatitis C transmission needlestick 0.5 to 1.8% risk of transmission Resident Surgeon Work Duty Hours ACGME has restricted work hours in order to address impaired performance by residents caused by long duty hours Duty hours include clinical time academic hours administrative work time on call no more than 1 day per every 3 days in house must include a 10-hour period of "off-time" between clinics on-call restricted to 80 or less per week (averaged over a 4 week period) 10% increase allowed if justified by educational value 1 day in 7 must be a day off (averaged over 4 week period) Results of new duty hours early evaluations have caused concern over issues of patient safety continuity of care communication and transfers in care have been cited as sources of decreased continuity of care as a sequelae of the 80-hour resident physician work week