Patient outcomes are a regular topic among healthcare practitioners. In the field of interventional cardiology, a strong emphasis has been placed on improving patient care by leveraging the latest technologies such as bioresorbable stents, implementing transradial programs to reduce potential complications, and reducing things like contrast usage and radiation dose. Until recently, little attention was paid to the serious risks interventional cardiologists and cath lab personnel face when performing PCI procedures. In the last year, several studies have emerged highlighting the effects and risks of radiation exposure in the cath lab. Here are 5 of the most studied risks:
Orthopedic injury: Interventionalists have high rates of orthopedic injury. Long hours of standing at the patient table, combined with the weight of leaded personal protective equipment (PPE) exert continuous pressure on the musculoskeletal system. In a recent Society for Cardiovascular Angiography & Interventions (SCAI) member survey, approximately 50 % of respondents reported at least one orthopedic problem. The Mayo Clinic also surveyed its interventional and non-interventional healthcare professionals about musculoskeletal problems. More than half of interventional professionals reported work-related pain, which was significantly higher than non-interventional workers. [i]
Brain tumors: Interventionalists are typically positioned with the left side of their body close to the patient’s chest and X-ray source. A study evaluating self-reported brain tumors in interventionalists has shown that in cases where tumor location is known, 86 % have been located on the left side of the brain.[ii] The recent BRAIN study quantified the differing radiation exposures to the left and right sides of the head. The average radiation exposure left side of the head was 4.7 times the dose of the right.[iii]
Vascular aging: New research provides evidence that continued exposure to low-dose ionizing radiation also increases cardiovascular (CV) risk. Carotid intima-media thickness (CIMT) and leukocyte telomere length (LTL) are markers for atherosclerosis and biological aging, respectively. A recent study showed that high-volume interventionalists had significantly higher CIMT compared to low-volume medical professionals. High-volume interventionalists also had significantly higher CIMT values on the left side of the neck but not the right. In addition, high-volume practitioners had significantly shortened LTL compared to the control group which has been found to be a predictor of CV disease and death.[iv]
Cataracts: The eye is highly radio-sensitive and cataracts is frequently reported among interventionalists and cath lab personnel. In one study, 50% of interventional cardiologists had lens changes that are a precursor to cataracts commonly associated with radiation exposure. Interventionalists with lens opacities had an estimated cumulative radiation dose to the eye that was 2.8 times higher than those without lens opacities.[v]
Thyroid disease: Recent studies have shown reports of structural changes to the thyroid as a result of radiation exposure which include malignant and benign thyroid tumors. The important thing to note is that these changes develop at a linear rate to dose exposure.vi
While a strong emphasis has been placed on reducing radiation exposure for patients, more needs to be done for the physicians and staff in the cath lab. Despite the high exposure to scatter radiation, only about 30 % of respondents in the SCAI survey reported wearing a radio-protective scrub cap and many reported routinely not wearing dosimeters if at all.[vi]i This goes to show that not only do hospitals need to find solutions to reduce risks from radiation exposure, physicians and staff need to educate themselves on their own personal risk and take steps to reduce their exposure.
[i] Orme NM, Rihal CS, Gulati R, Holmes DR Jr, et al. Occupational health hazards of working in the interventional laboratory: A multisite case control study of physicians and allied staff. J Am Coll Cardiol. 2015;65:820-6.
[ii] Roguin A. Radiation in cardiology: Can’t live without it! Eur H Journal. 2014;35:599-604.
[iii] Reeves RR, Ang L, Bahadorani J, Naghi J, et al. Invasive cardiologists are exposed to greater left side cranial radiation: The BRAIN study (Brain radiation exposure and attenuation during invasive cardiology procedures). JACC Cardiovasc Interv. 2015;8:1197-206.
[iv] Grazia Andreassi M, Piccaluga E, Gargani L, Sabatino L, et al. Subclinical carotid atherosclerosis and early vascular aging from long-term low-dose ionizing radiation exposure: A genetic, telomere, and vascular ultrasound study in cardiac catheterization laboratory staff. JACC Cardiovasc Interv. 2015;8:616-27.
[v] Vano E, Kleiman NJ, Duran A, Romano-Miller M, Rehani MM. Radiation-associated lens opacities in catheterization personnel: Results of a survey and direct assessments. J Vasc Interv Radiol. 2013;24:197-204.
vi E. Ron, R. Brenner, Non-malignant thyroid diseases after a wide range of radiation exposures. Radiation Research, 174:877-888 (2010).