Radiation Safety in Musculoskeletal Radiology: Addressing Challenges and Implementing Solutions

Background and Aims: Musculoskeletal (MSK) radiology is integral for diagnosing and managing traumatic, degenerative, inflammatory and neoplastic disorders. Many MSK imaging modalities, particularly computed tomography (CT) and fluoroscopy, involve ionising radiation, raising concerns about cumulative patient dose, especially in children, pregnant women and patients undergoing repeated imaging for chronic or cancer-related conditions. Purpose: To review current challenges in radiation safety within MSK radiology and to highlight strategies, technologies and workflow modifications aimed at minimising radiation exposure while maintaining diagnostic accuracy. Importance is given to artificial intelligence (AI) and its applications for dose optimisation. Content: The review outlines radiation protection principles (justification, optimisation, dose limitation) and their application to MSK radiology. Specific focus is given to paediatric imaging (emphasising protocol tailoring, non-ionising alternatives and ALARA compliance), pregnancy and trauma (dose mitigation during urgent imaging and obstetric safety considerations), chronic disease and cancer surveillance (balancing diagnostic yield with dose tracking and cumulative exposure management), technology solutions (AI-based dose optimisation, synthetic CT generation from MRI, dual-energy CT, low-dose CT protocols), emerging innovations (photon-counting CT, robotic ultrasound, low-field portable MRI, and augmented reality guidance for interventions) and operational strategies (radiation safety audits, adherence to diagnostic reference levels (DRLs) and occupational protection measures, and real-time dosimetry). Summary: Radiation safety in MSK radiology is a multidisciplinary responsibility requiring integration of optimised protocols, modern technology, AI applications and adherence to international safety standards. Practical recommendations provided in this review aim to minimise radiation risks to both patients and healthcare workers while ensuring high diagnostic quality in MSK imaging.