Radiation, Surgical Smoke, and More: What Orthopaedic Surgeons Need to Know About Occupational Exposures

The views expressed are the speaker's own and do not represent the official position of the United States Air Force, the Defense Health Agency, or the United States Government.

In this episode of the AAOS Career Podcast, host Ellen Lutnick, MD, is joined by Mary Carnduff, MD, MBA, FAAOS, Commander and Director, Mike O’Callaghan Military Medical Center, and Chair of the AAOS Committee on Healthcare Safety. Building on the previous episode about occupational musculoskeletal injuries, Drs. Lutnick and Carnduff turn to a different set of workplace hazards: radiation, surgical smoke, noise, chemical exposures, and infectious disease transmissions in the operating room.

Dr. Carnduff shares how her years as a firefighter shaped her interest in protective habits and workplace culture. She explains which exposures matter most for orthopaedic surgeons and what the current evidence says about each one. She also offers practical guidance on protective equipment, reporting injuries, and building safer habits during training.

The conversation closes with advice for residents on speaking up about safety concerns and how to help shift the culture of orthopaedics to put the safety of surgeons and OR personnel on par with patient safety.

Key topics covered in this episode:

• Why Dr. Carnduff became interested in occupational exposures, and the similarities between firefighting and orthopaedic surgery cultures

• Radiation as the most pervasive operating room exposure, including protection for the eyes, thyroid, and breast

• The importance of properly fitted lead and why ill-fitting gowns can leave at-risk areas exposed

• Emerging data on higher rates of breast cancer in female orthopaedic surgeons and prostate cancer in male orthopaedic surgeons, and the Committee on Healthcare Safety’s work on possible screening recommendations

• Practical radiation-shielding habits, including standing two meters away, taking two steps back during imaging, and using personal thyroid shields

• How the mini C-arm compares to the standard C-arm in scatter, the pros and cons of using thicker lead, and when lead gloves may be worth considering

• What is found in surgical smoke, including carcinogens, bacteria, and viruses, and why smoke evacuators can make a huge difference

• Why surgical hoods and PAPRs are not designed to protect against inhaled exposures, and the role of N95 masks

• What the current science says about PMMA bone cement and pregnancy, and why respecting a resident’s comfort level with exposures during pregnancy matters

• How common needle sticks and sharps injuries are in orthopaedics, why many go unreported, and why it’s important to follow hospital protocol after an incident

• Common PPE gaps, including eye protection and hearing protection, and the noise levels of power equipment

• How residents can advocate for their – and others’ – safety in the OR by defining the problem, reviewing the literature, and making a fact-based case for change

• Shifting the culture through modeling good habits, removing unsafe equipment, and redefining what a successful career looks like

As Dr. Carnduff emphasizes, small protective habits formed early can feel like second nature over time and help to ensure a long, fulfilling career in orthopaedic surgery.

Host: Ellen Lutnick, MD, Resident Assembly Executive Committee Chair

Guest: Mary Carnduff, MD, MBA, FAAOS, Commander and Director, Mike O’Callaghan Military Medical Center, and Chair, AAOS Committee on Healthcare Safety