# Occupational Radiation Risk Stratification and Protection in Fluoroscopy-Guided Surgeons and Interventionalists: A Multispecialty Structured Narrative Review

## TL;DR

This review examines radiation risks for surgeons using fluoroscopy and evaluates how protective gear and practices can reduce exposure and cancer risks.

## Contribution

The paper provides a structured narrative review on occupational radiation exposure and protection strategies across multiple surgical specialties.

## Key findings

- Lead aprons and thyroid collars significantly reduce radiation exposure, but eye and lower-body shielding are inconsistently used.
- BEIR VII modeling suggests increased cancer risks for chronically exposed operators, though epidemiologic data is limited.
- High compliance with some protective measures coexists with variability in exposure and inconsistent adherence to full shielding protocols.

## Abstract

Background/Objectives: Fluoroscopy-guided procedures are widely used across surgical and interventional specialties but expose operators to ionizing radiation with associated stochastic and deterministic effects. The aim is to characterize occupational radiation exposure, evaluate the effectiveness of shielding strategies, assess long-term cancer risks, and identify compliance patterns. Methods: This structured narrative review summarizes evidence on operator dose, shielding effectiveness, compliance with protective practices, and long-term cancer risk. A search of PubMed, Scopus, Embase, and Web of Science (limited to January 2000–March 2024) identified 62 records; 27 full texts were reviewed, and 16 studies met the inclusion criteria. Results: Across studies, unshielded chest exposure averaged 0.08–0.11 mSv per procedure, and eye exposure averaged 0.04–0.05 mSv. Lead aprons reduced exposure by about 90% at 0.25 mm and 99% at 0.5 mm, thyroid collars reduced neck dose by 60–70%, and lead glasses reduced ocular dose 2.5–4.5-fold. Compliance with aprons and thyroid collars was high, whereas lead glasses and lower-body shielding were inconsistently used. Limited epidemiologic data suggested a higher cancer burden in exposed surgeons, and Biologic Effects of Ionizing Radiation (BEIR) VII–based modeling projected increased lifetime risks of solid cancers in chronically exposed operators. Conclusions: Protective equipment substantially reduces operator dose, but exposure variability and inconsistent shielding practices persist and justify standardized monitoring, stronger enforcement of radiation safety protocols, and longitudinal studies.