Survey reveals gaps in radiation risk awareness among female orthopaedic surgeons

Knowledge of radiation safety is critical for orthopaedic surgeons who face exposure daily. As more women enter the field of orthopaedic surgery, radiation-safety education and equipment may need to be tailored to address health issues such as women-specific cancers.

A study presented at the AAOS 2025 Annual Meeting investigated radiation-safety knowledge and compliance among female orthopaedic surgeons. In an interview for AAOS Now, study coauthor Alexandra Spath, an MD candidate at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo, discussed the results of the study, suggestions for practicing surgeons, and future directions for research.

Spath explained that the aim of the study was to hear from female orthopaedic surgeons specifically about their knowledge of radiation safety, including “how they felt their radiation-safety education training was — if they had an adequate amount — and how that translates to their compliance with radiation-safety protocols.”

The study used a three-part online survey distributed online through the Ruth Jackson Orthopaedic Society and the Women in Orthopaedics Facebook group. The first part collected demographic information. The second part of the survey assessed respondents’ knowledge of radiation safety. The third section of the survey focused on respondents’ personal experiences with radiation, including how frequently they were exposed, their satisfaction with the radiation-safety training they had received, their own radiation-safety practices, and their level of concern about their exposure risk.

In total, 66 female orthopaedic surgeons from 21 states completed the survey. Most respondents were aged 30 to 49 years (77.3%) and had been practicing for nine years or fewer (62.1%).

Radiation-safety education
According to Spath, the survey revealed a median score of 6/10 on the knowledge assessment, which included basic radiation-safety principles. Overall, 91% of participants felt that radiation-safety education could improve, with about 60% of respondents rating their training as unsatisfactory or extremely unsatisfactory. Additionally, only 48.5% reported that they had lectures about radiation safety during their training and felt they had adequate knowledge of radiation safety.

She acknowledged that it may be difficult to find time during residency for additional radiation-safety training, suggesting it be integrated into third-year medical student curricula or residency orientations. “Although it is an extra hurdle, it’s an important step that I think needs to be addressed,” she noted.

PPE and dosimeter use
Findings suggest that many surgeons do not comply with radiation-safety protocols, with only 24.2% of respondents reporting regular dosimeter usage. Additionally, 62% admitted to never wearing a dosimeter — a precaution that Spath mentioned is highly recommended in the AAOS Information Statement on Radiation Safety.

Personal protective equipment (PPE) was more regularly used by respondents, with 80% reporting that they always use PPE and 20% reporting that they used it most of the time.

However, proper fit was a concern shared by respondents. “We found that [around] 35% of participants felt there was adequate PPE provided that fit them, although the majority of our respondents owned their own PPE. They had to go out of their way to buy custom lead,” she explained.

Spath also discussed the implications of ill-fitting PPE and inadequate protection against radiation exposure for women in orthopaedic surgery.

“As women are just starting to enter the field of orthopaedics and are not a large majority yet, a lot of the lead is catered to their male counterparts. Sometimes the lead fits larger, especially in the arm region, [where it could be] hanging down low,” she said. “The upper outer quadrant of the breast is one of the most commonly targeted areas for breast cancer, and having the radiation going there, where there’s not adequate coverage, could potentially be one of the causes for an increased risk of breast cancer in orthopaedic surgeons.”

Practical tips for radiationsafety
Spath urged orthopaedic surgeons to recognize the long-term risk associated with a lenient mentality toward radiation safety.

“It’s really easy during longer cases, especially for surgeons, to say, ‘We can skip lead. It’s only going to be a few pictures.’ Or if you’re in the emergency room to not wait to get lead, to just snap the picture quickly. It does add up,” she cautioned.

She also emphasized that minimizing radiation exposure does not stop with the gown, reminding surgeons that there are also thyroid shields and eye protection. “Lead glasses aren’t something that are commonly used, but cataracts are common things seen in older orthopaedic surgeons from radiation,” Spath noted.

In addition to suggesting further surveys to gather feedback on training and protocol adherence, Spath encouraged surgeons to explore how well protocols are being followed at their own institutions and lead by example in promoting radiation safety.

Heather Knox is associate editor of AAOS Now. She can be reached at hknox@aaos.org.

Reference

1. Spath AR, Alaia EF, Chalem I, et al. Radiation safety among female orthopaedic surgeons. Paper presented at: AAOS 2025 Annual Meeting; March 10-14, 2025; San Diego, California.