RADIATION SAFETY AND PATIENT PROTECTION IN HYBRID OPERATING ROOMS: AN INTERPROFESSIONAL SYSTEMATIC REVIEW OF THE ROLES OF RADIOLOGIC TECHNOLOGISTS, ANESTHESIA TECHNICIANS, AND MEDICAL PHYSICISTS

Abstract

Background: Hybrid operating rooms combine a sterile surgical theatre with fixed, high-output angiographic and cone-beam computed tomography (CBCT) imaging. They improve procedural precision but expose patients to substantial radiation and place a multiprofessional team, including staff who are not radiation specialists, close to scattered radiation. Radiologic technologists, anesthesia technicians and medical physicists each hold part of the responsibility for protection, yet their combined contribution has not been synthesised.

Objective: To systematically review the evidence on occupational and patient radiation safety in hybrid operating rooms and fluoroscopy-intensive procedural settings, with a focus on the roles of radiologic technologists, anesthesia personnel and medical physicists, and to compare Saudi Arabian evidence with the international literature.

Methods: The review followed PRISMA 2020. PubMed/MEDLINE was searched from January 2010 to 23 October 2026 with 17 search strings, supplemented by a targeted search for Saudi studies. Primary studies and systematic reviews reporting staff dose, patient dose, dose-reduction interventions, or radiation-protection knowledge and practice among hybrid-OR or peri-procedural teams were eligible. Data were extracted into a structured table, quality was appraised with design-specific criteria, and findings were synthesised narratively across four domains.

Results: Of 360 screened records, 36 studies were included (29 international, 7 Saudi). Occupational doses in hybrid operating rooms were generally below the 20 mSv annual limit; a Saudi national registry of 7,530 operating-room workers reported a mean annual effective dose of 0.59 mSv. Exposure was nonetheless uneven: digital subtraction angiography increased operator dose up to 33-fold, anaesthesiologists in neuro-interventional work received facial doses 3.2 times those of the radiologist, and anaesthesia technologists in a Saudi cohort received higher doses than consultants (0.80 vs 0.63 mSv). Shielding and positioning measures reduced dose by 71–90%, equipment and protocol optimisation by 22–76%, and education or simulation by 16–79%. Saudi surveys showed marked gaps: only 3.9% of orthopaedic surgeons had formal radiation-protection training, 19.6% wore a dosimeter, and 76% of non-radiology staff had low awareness.

Conclusions: Radiation safety in hybrid operating rooms depends on coordinated action across professions: medical physicists set and audit protocols, radiologic technologists translate them into exposure choices at the table, and anesthesia staff, who are often closest to the scatter field and least trained, need dedicated shielding, monitoring and education. Saudi hospitals record low average doses but weak training and monitoring culture, which supports a structured, team-based radiation-safety programme.