Occupational radiation exposure has serious adverse effects on health, including increased risk of cataracts, leukaemia, solid organ cancers and thyroid disorders [1,2]. Training in radiation protection, mandated by European Union directives, is a legal requirement for healthcare staff involved in the practical aspects of medical radiological procedures [[3], [4], [5]]. This is also highlighted in the UK regulation under ‘Ionising Radiation (Medical Exposure) Regulations 2017’, which details the duties of the employer and safety needs that must be met in any facility that holds radiation-emitting equipment [6].

The occupational whole-body radiation exposure for “category A″ exposed workers is 20 mSv per year, and for category B workers outside the radiology department, it is 6 mSv per year, according to the National Committee on Radiation Protection and Measurements (NCRP) [7] Guidance which is based on the United Nations Commission on the Effects of Ionising Radiation (UNCEIR) [8] and the National Academy of Sciences in the Biological Effects of Ionising Radiation (BEIR) [9] and according to the European Commission [10]. The general public's whole body radiation exposure is 1 mSv per year, and if a worker is not classified as an exposed worker, the public dose limit applies. There is no requirement to provide a dosimeter to workers who are not ‘exposed workers’ [10]. Surgeons fall into the same category as the general public. According to the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), “there is evidence that a dose accumulated over a long period carries less risk than the same dose received over a short period”, with regards to cancer risk development, however, the level of radiation is not noted specifically [11]. The Agency also notes It is important that any person exposed to or using radiation emitting equipment must have appropriate radiation safety training and be compliant with wearing personal protection equipment (PPE) [12].

With the increasing use of intraoperative fluoroscopy in many surgical specialtiesOperator knowledge of radiation safety and protective practices is of utmost importance in achieving the ‘As Low As Reasonably Achievable’ (ALARA) radiation dose [13]. A recent systematic review by Malik et al. demonstrated that trainees have a higher total fluoroscopy time and a higher mean radiation exposure compared to more experienced surgeons [14]. Previous studies have highlighted a gap in surgical trainees' knowledge surrounding radiation safety due to a lack of education [15].

This study aims to assess surgical trainee knowledge of occupational radiation exposure and safety, and prior attendance at radiation protection training. We also sought to assess compliance with the use of personal protective equipment (PPE) and trainees' attitudes and concerns relating to radiation exposure.