Protecting Interventional Cardiologists From Radiation Exposure

Posted by Corindus Staff
May 23, 2014

Of the human-made radiation dose to which US citizens are exposed, 90% is from medical imaging tools1. It’s widely known that interventional cardiologists (ICs) have the most occupational radiation exposure of any medical profession. In one recent study, the hospital radiation badges that most commonly exceeded established radiation limits were worn by those in the cardiology division. Since workloads and the complexity of procedures such as PCI, also known as angioplasty, have increased over the past few years (without a real increase in the number of specialists available) fewer ICs are handling more cardiology procedures and subsequently are being exposed to more and more radiation. Long-term “low” level radiation (like what medical professionals are exposed to during cardiology procedures) can pose a serious health risk overtime as well1. Cardiac catheterization, in particular, can be a major source of radiation exposure for healthcare professionals.


Dr. David Clark wrote, ‘‘There is ongoing concern about how experienced interventionalists and younger ones with long careers ahead of them can avoid the potential ravages of Xray exposure. On a monthly, yearly, and lifetime basis, how much radiation exposure is acceptable, and how much radiation exposure puts an individual at increased risk of which complications?’’2


Personal shielding options like lead aprons, thyroid collars and leaded eye protection can help protect cardiologists from much of the radiation, but personal shielding options don't cover every square inch of the body, nor do they always extend to the body parts that are the most at risk. For example, cardiologists’ hands receive the highest X-ray exposure during catheterization and electrophysiology procedures because their hands are closest to the X-ray beam. In fact, the first cancers that were reported due to X-ray exposure were skin cancer in the hand among physicians, dentists, physicists and X-ray technologists in the late 1890s and early 1900s.1 Leaded latex gloves, while an important safety precaution, only offer limited radiation shielding capability, stopping approximately 20% to 30% of the X-ray beam.


An Israeli research team recently found that the head of the cardiologist, in comparison to the rest of the body, is very unprotected "during interventional and certain electrophysiological procedures "and therefore is particularly exposed to radiation." They state that radiation dose received annually in adult cardiology is equivalent to 20 to 30 mSv (equal to 1000-1500 chest X-rays), "And the left side of the head is as twice as exposed compared with the right, as the cardiologist stands during the procedure on the right of the patient with the radiation source to the left." Researchers were able to obtain data on tumor location in 30 of the 36 cases the tracked, and in 86% of these cases the malignancy was left-sided.3 Existing radiation shield devices for physicians typically shield the trunk and thyroid but provide little protection for the head. Much like their hands, a physician's head is left exposed to extensive amount of radiation over their lifetime.


Many hospitals do not allow their female staff and physicians to practice in the cath lab during their pregnancy. When female interventional cardiologists and staff are allowed to practice while pregnant, they are required to wear double lead around their abdomen. This clearly indicates that the risk is tangible.


If the cardiologist increases their distance from the X-ray beam from just 2 feet to 4 feet, there is a reduction in waist level radiation exposure to as little as one-fourth of the original level. Studies have also shown that the exposure of a nurse stationed just a few feet from the primary X-ray beam operator was 2% to 11% of the total dose at the X-ray source.1 A few feet extra can mean medical professionals are exposed to 90+% less radiation, simply by standing farther away. But while nurses might be able to move farther away from the X-ray beam during the procedure to minimize their exposure, the primary operator is stuck next to the beam for the entire process.


However, one of our key benefits with the CorPath System is the ability to put the physician behind a radiation-shielded cockpit, reducing their exposure by over 95%*. Their hands and heads, which were receiving the most exposure before, are now nowhere near the X-ray beam. The physician can now perform the procedure using joysticks and touchscreen controls to both measure anatomy and place stents with robotic precision. By placing the physician in a safer working environment, we hope to improve the lives of both physicians and patients.


Click here to download a free issue brief on operator safety in complex PCI


1. Limacher, MC; et al. (1998). Radiation Safety in the Practice of Cardiology. Jour Am Col Cardiol, 31: (4), 892-913.(2006).
2. Dehmer, GJ; et al. (2006). Occupational Hazards for Interventional Cardiologists. Catheterization and Cardiovascular Interventions, 68, 974-6.
3. Roguin A. Radiation hazards to interventional cardiologists: A report on increased brain tumors among physicians working in the cath lab. SOLACI 2014; April 23, 2014; Buenos Aires, Argentina.
*Compared to levels found at the traditional table position



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