Radiation safety -it's in our hands: a practical video supplement to improve radiation safety in hand surgery

Intra-operative radiographic imaging is indispensable in modern hand surgery but exposes surgeons' hands to significant ionising radiation. In theSHIELDmulticentre audit performed across all Irish Plastic Surgery units, non-patient anatomy appeared in 51.7% of saved intra-operative images, highlighting a persistent gap between ALARA ('As Low As Reasonably Achievable') principles and real-world practice. To address this problem, we developed a professionally-produced, educational video demonstrating simple, low-cost techniques that maintain working distances during x-ray acquisition. Using common instruments like artery clips, skin hooks, long forceps, and radiolucent syringe barrels, the video provides step-by-step demonstrations tailored to hand surgery. Feedback from national dissemination has been positive, with trainees and consultants circulating the video-based tool. In parallel,Spark Innovation Seedfunding was secured to help design a purpose-built operative tool that allows precise manipulation while keeping the surgeon's hands outside the x-ray field. This article introduces the video as a practical training resource and highlights its potential as a standardised, low-barrier intervention to improve radiation safety in hand surgery.