Occupational Ionizing Radiation-Induced Skin Injury Among Orthopedic Surgeons: A 5-Year Longitudinal Cohort Study.

Background: This 5-year longitudinal study evaluated changes in occupational radiation exposure and radiation-induced skin injury among orthopaedic surgeons, focusing on the effects of educational campaigns. Methods: Orthopaedic surgeons at Hirosaki University were surveyed in 2019 and 2024. Self-reported weekly fluoroscopy ("beam-on") time and dermatologist-graded hand skin findings were compared. Educational campaigns (2020-2023) emphasized As Low As Reasonably Achievable principles and personal protective equipment. We hypothesized that repeated education would improve radiation-safety attitude, reduce self-reported fluoroscopy time, and mitigate dermatologic injury. Results: The proportion of surgeons cautious about radiation increased from 5.8% to 70.9%. The median weekly self-reported fluoroscopy time decreased from 9.5 to 8.0 minutes (p = 0.045). The prevalence of radiation-induced skin injury declined from 34.9% to 25.6%. Inter-rater reliability was excellent (weighted κ = 0.910). Nonspine surgeon status predicted improvement in skin condition. Conclusions: During the 5-year period in which repeated radiation-safety education was conducted, surgeons demonstrated improved safety attitudes, decreased self-reported fluoroscopy time, and improved dermatologist-graded skin findings. These observations indicate an association between educational activities, self-reported exposure, and skin findings, but do not establish causality because exposure was self-reported and the study lacked a control group. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.