Hearing Her Concerns: Gender and Radiation Discourse Among Cardiovascular Interventionists in China: Social Media Analysis (Preprint)

BACKGROUND Women remain underrepresented in radiation-based cardiovascular procedures, and occupational radiation concerns are a leading career deterrent. How these concerns surface in everyday professional discourse, particularly in China, is poorly documented. OBJECTIVE We aimed to compare radiation-related discourse by author gender among cardiovascular interventional professionals on Xiaohongshu (RedNote), China's largest female-dominant social platform, and to characterize themes that are rarely captured by workforce surveys. METHODS In October 2026, we collected public Xiaohongshu posts through systematic keyword searches (59 query groups in 3 iterative waves) and full sampling of 12 key opinion leader accounts, yielding 2,300 deduplicated posts and 27,881 comments with nested replies. Posts were coded for author role, 9 radiation-related themes, and affective valence (cost, neutral, empowerment) using rule-based pre-screening followed by human-supervised large language model (LLM)-assisted adjudication, with full-text review of all practitioner-authored posts. Author gender was ascertained from platform profile fields with in-text self-presentation as fallback. Proportions were compared with χ² tests, with author-level analysis to address clustering. RESULTS Of 2,300 posts, 1,027 were authored by health care practitioners (405 female, 376 male, 246 unknown gender; 576 unique authors). Cost-valence discourse was twice as prevalent among women as among men (21.5% vs 10.6%; χ²₁=16.84; P<.001) and persisted at author level (32.9% vs 20.1%; P=.007). Among posts explicitly addressing radiation, cost content was expressed in 35.8% of female-authored versus 21.6% of male-authored posts (P=.07). Fertility and pregnancy concerns (10.4% vs 1.1%; P<.001) and gendered workplace culture (9.1% vs 0.8%; P<.001) were almost exclusively female-authored and spanned all career stages, from specialty selection to pregnancy and return to the table. Empowerment content was nonsignificantly more common among women (14.3% vs 10.4%; P=.09). Comment-layer analysis (341 retained comments) added partner fertility anxiety, pregnancy-related scheduling penalties, operator health effects, and gatekeeping voiced mainly by women (10 of 15 known-gender comments). Posts by patients and family members were predominantly female-authored (86.7% of 255 known-gender authors). CONCLUSIONS On China's largest female-dominant social platform, female cardiovascular interventional professionals described the costs of occupational radiation at twice the rate of male peers, while also producing more empowerment content. The fertility-radiation conflict was voiced already at the specialty-selection stage and extended to operators' partners and patients, identifying actionable targets for protection, staffing, and counseling.