ALARA+: Summit on Radiation and Orthopedic Risks in Fluoroscopic Laboratories: Endorsed by ACC, ACVP, ASE, HRS, SCAI, SIR, SNIS, SVIN, and SVS.

Occupational radiation exposure has a clear association with long-term health effects and has a particular impact on women, trainees, and supporting staff. There is a reliance on limited, traditional radiation protection and nonergonomic equipment, which carries associated orthopedic injury rates with adverse impacts on both individual career trajectories and health systems, and with significant challenges to widespread implementation of enhanced radiation protection devices. During the 2025 Society for Cardiovascular Angiography & Interventions Scientific Sessions in Washington, DC, a multidisciplinary Think Tank summit was convened and included representatives from multiple stakeholders, including other professional societies, advocacy groups, and industry partners. The focus of discussion was on the dual dangers of both ionizing radiation and the musculoskeletal injuries associated with current-generation protection equipment. This document summarizes the main points of discussion and outlines actionable next steps to advocate for more widespread implementation of enhanced radiation protection technologies and imaging systems in order to achieve ALARA+ (as low and as light as reasonably achievable).