Abstract
Background and Objectives: C-arm fluoroscopy is used across virtually every anatomical region and target disease in orthopaedic, spinal, and interventional practice, yet the operator’s own radiation burden is rarely quantified at the point of care. Published dose data are fragmented across procedure-specific studies using incompatible dosimetric quantities, making it difficult for a surgeon to answer this simple question: how much radiation am I receiving during this case, and how many such cases are safe? This narrative review synthesises the available evidence into a region- and procedure-indexed reference, and derives a transparent arithmetic framework that allows an operator to estimate personal dose from quantities displayed on the C-arm console. Materials and Methods: We searched PubMed/MEDLINE, Scopus, and Google Scholar for English-language studies published between January 1990 and May 2026 reporting operator or patient radiation dose during mobile C-arm or mini C-arm fluoroscopy in musculoskeletal, spinal, and fluoroscopically guided pain procedures. Priority was given to open-access primary dosimetry studies, phantom experiments with explicit geometry, systematic reviews, and international radiological protection guidance. Reported quantities were harmonised to SI units and, where possible, converted to a common basis using published dose conversion coefficients. Results: Operator dose per procedure spans approximately four orders of magnitude, from below 1 µSv for extremity work to more than 200 µSv to the extremities during percutaneous spinal instrumentation. Three variables—beam-entry geometry, operator distance, and personal shielding—dominate this variance and account for effects far larger than the choice of anatomical target itself. Torso dose rates differ by more than twenty-fold between the tube side and the detector side of the patient. Distance follows the inverse-square law, such that a single step from 30 cm to 100 cm reduces scatter by approximately 91%. A 0.5 mm lead-equivalent apron attenuates roughly 95% of scattered radiation to the shielded torso. Counterintuitive findings recur: mini C-arm systems can deliver higher entrance skin dose and higher scatter than a standard C-arm under matched geometry, and metal instrumentation in the field can raise assistant eye dose by two orders of magnitude. Regulatory limits are, for most orthopaedic operators, reached only theoretically; for operators performing a high annual volume of fluoroscopically guided procedures, the binding constraints are the equivalent doses to the eye lens and the hands, not whole-body effective dose. Conclusions: The operator’s radiation burden in C-arm fluoroscopy is predictable from a small number of measurable quantities and is dominated by modifiable geometry rather than by the disease being treated. A three-parameter estimation framework—the 0.1% scatter rule, the inverse-square correction, and a shielding transmission factor—reproduces published per-procedure doses within an order of magnitude and can be applied intraoperatively to any region or indication. Region-specific dose tables should be used as reference values for local optimisation rather than as absolute expectations.