• Lack of Evidence-Based Practice: There is a significant gap in evidence-based practices related to radiation protection. Our understanding of global standards and practices, as well as their long-term impact on operator health, remains limited. Standardising current procedures and establishing a uniform database for data entry by all practitioners performing X-ray-based procedures would be beneficial.
• Lack of tailored measures to enhance protection for Female Operators: Female operators are at a greater risk of radiation exposure (Front Genet 10:260, 2019), underscoring the need for comprehensive guidance and standards to mitigate both short—and long-term health risks. Research and higher-level evidence are essential to evaluate the efficacy of current practices, along with better access to tools for accurate fetal dose calculation when needed.
• Balancing Protection and Ergonomics: It is crucial to achieve the right balance between adequate lead protection and ergonomic considerations for the spine and musculoskeletal system. The minimum level of lead protection scientifically required to ensure operator safety without compromising comfort and posture must be determined.
• Lack of accurate data regarding the log of health issues for personnel working with radiation gears. A national or international anonymised registry would be ideal for capturing and monitoring such data.
Supplementary Information: The online version contains supplementary material available at 10.1186/s42155-025-00540-3.