Radiation in the Orthopedic Operating Room: What We Know, What We Do, and What Needs Attention.

Surgeons and operating room staff are frequently exposed to ionizing radiation, particularly during fluoroscopy-guided procedures in trauma and spine surgery. Despite established safety protocols, significant gaps remain in awareness, training, and adherence to best practices. While personal protective equipment such as lead aprons, thyroid shields, and lead glasses is effective, their inconsistent use leaves healthcare workers vulnerable. Recent studies raise particular concern over elevated cancer risks, including breast cancer among female orthopedic surgeons. Technological improvements and procedural modifications, such as pulsed fluoroscopy and optimized C-arm positioning, reduce exposure considerably but require wider adoption. Greater emphasis on education, adherence to regulations, and gender-specific research is essential to enhance radiation safety and protect the orthopedic workforce. This narrative review focuses on the risks associated with ionizing radiation use in orthopedic surgery, factors influencing exposure, as well as techniques and protective equipment that can be utilized to lower the risk.