Fluoroscopy use and radiation safety in orthopedic surgery: a cross-sectional survey of knowledge and protective behaviors

Objective: This study aimed to assess orthopedic surgeons’ knowledge and protective behaviors related to intraoperative fluoroscopy, and to examine the impact of professional experience and different healthcare setting contexts. Methods: A cross-sectional online survey was distributed between January and March 2024 to actively practicing orthopedic surgeons. The questionnaire included 36 structured items covering demographics, fluoroscopy usage patterns, protective equipment habits, training background, and radiation-related symptoms. Knowledge and behavior scores were calculated and analyzed using appropriate statistical tests. Results: A total of 230 orthopedic surgeons participated. The mean knowledge and behavior scores were 48.7 Å} 11.6 and 70.7 Å} 14.2, respectively. While lead apron use was high (82.2%), the use of thyroid shields (68.7%), lead goggles (12.6%), gloves (5.7%), and dosimeters (7.0%) remained limited. Only 23.9% of participants had received radiation safety training. Surgeons with more than 10 years of experience had significantly higher behavior scores (P = .006). Differences in behavior scores were observed across country of employment, including Türkiye (P < .001). Regression analysis identified age (P = .035), knowledge score (P < .001), and country of employment (P = .001) as independent predictors of behavior score. Age was also independently associated with higher knowledge scores (P = .026). Symptom reporting after fluoroscopy use was not significantly associated with behavior scores (P = .372). Conclusion: Fluoroscopy use in orthopedic surgery remains insufficiently supported by protective behavior, despite moderate knowledge levels. Low use of dosimeters and complementary equipment reflects both individual and systemic shortcomings. Enhancing radiation safety requires not only improved knowledge but also implementation of mandatory, behavior-focused training supported by institutional policies. Cite this article as: Kaya O, Dalkir KA, Olke HC, Mirioglu A, Tekin M. Fluoroscopy use and radiation safety in orthopedic surgery: A cross-sectional survey of knowledge and protective behaviors. Acta Orthop Traumatol Turc. 2026; 60(3), 0521, doi: 10.5152/j.aott.2026.25521.