Knowledge And Compliance To Occupational Radiation Protection In Endovascular Procedures: A National Cross-Sectional Survey Among Vascular Surgeons In Brazil

Introduction: The advent of Endovascular surgery and the use of fluoroscopy-guided procedures have grown in the last decade, and with that increased the exposure of surgeons to cumulative ionizing radiation, increasing the risk of occupational health complications. Despite established radiation protection principles, adherence to radioprotection measures and surveillance practices remains uncertain in many settings. This study aimed to evaluate knowledge, availability, and implementation of radiation protection strategies among vascular surgeons in Brazil Metology: A national cross-sectional survey was conducted in February 2026 using an anonymous online questionnaire distributed to all active members of the Brazilian Society of Angiology and Vascular Surgery (SBACV). Associations between participant characteristics and radioprotection practices were explored using chi-square or Fishers exact tests. Results: Of 4,698 invited members, 192 vascular surgeons met the inclusion criteria. Most participants were male (67.4%), with a mean age of 45.9 years and a median of 12 years of experience performing fluoroscopy-guided procedures. Basic PPE use, particularly lead aprons, was nearly universal; however, adherence to other protective measures was substantially lower. Most respondents reported employing radiation-reduction strategies, including minimizing fluoroscopy time (98.9%), collimation (90.6%), optimized table and detector positioning (88.3%), procedural planning (87.2%), and pulsed fluoroscopy (81.0%). Only 19.4% reported undergoing annual medical surveillance for radiation-related health effects. Cataracts were the most frequently reported radiation-associated condition (6.2%). Greater age and professional experience were associated with higher utilization of selected protective measures and advanced imaging strategies. Conclusion: The study provides important insights into how radiation protection is currently understood and implemented in contemporary Brazilian vascular surgery practice. The incomplete use of personal protective equipment (PPE), with many justifications in addition to the low surveillance of the effects of radiation on health, brings us an alert about the reality in Brazil.