Authors’ reply to Milman and colleagues

Our editorial emphasises deficiencies in knowledge regarding occupational breast cancer in female surgeons and highlights that robust longitudinal data are needed.1Milman and colleagues’ letter2 demonstrates the need for medical physicists and healthcare workers to work together to improve safety by understanding how intraoperative radiation is used in practice and the limitations of current equipment. They criticise the orientation of the fluoroscopic C arm in studies by Valone et al3 and Van Nortwick et al4 which assess the effectiveness of standard and breast covering radiation protection using C arm positions commonly used in orthopaedic procedures. The radiation source is often positioned beside the operating surgeon to allow for orthogonal imaging around the pelvis or limb. Operative techniques and control of instruments can require the surgeon to stand beside the source with raised arms, exposing an unprotected axilla to radiation. This positioning has developed from C arm design, operating room configurations, technical…
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