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Diagnostic reference levels are radiation dose levels in medical radiodiagnostic practices for typical examinations for groups of standard-sized individuals for broadly defined types of equipment. This study aimed to establish local and contribute to national/international diagnostic reference levels for common hand and wrist procedures using mini C-arm fluoroscopy. Data were collected from fluoroscopy logbooks and were cross-referenced against the audit log kept on the machines. A total of 603 procedures were studied. The median radiation dose for wrist fracture open fixation was 2.73cGycm2, K-wiring procedures 2.36cGycm2, small joint arthrodesis 1.20cGycm2, small joint injections 0.58cGycm2 and phalangeal fracture fixation 1.05cGycm2. Wrist fracture fixation used higher radiation doses than phalangeal fracture fixation, arthrodeses and injections. Injections used significantly less radiation than the other procedures. There are significant differences in total radiation doses when comparing these procedures in hand and wrist surgery. Institutional audit data should be collected regularly and should be stratified by procedure type.
