A safer cath lab

The cardiology community has heeded the call to protect patients from radiation exposure in the cath lab. Now it is time to focus on the operators and staff.

Some patient radiation exposure is all but inevitable during PCIs and other procedures that require imaging. But for many patients, this may be a one-time occurrence. Interventional cardiologists and staff, on the other hand, may perform several procedures a day and work several days a week in the cath lab.

They can adhere to safety practices that minimize their exposure to scattering and other potential hazards. That includes wearing protective gear such as lead aprons, maximizing shielding, taking advantage of capabilities in newer imaging devices or using robotic systems. Many of these practices have been developed to reduce the long-term health risks.

Two recently published studies highlight more concerns for the cath lab personnel. The Society for Cardiovascular Angiography and Interventions released results of a survey on occupational hazards in the cath lab that showed more than half of operators experienced some kind of orthopedic injury.

Interventional procedures are becoming increasingly complex with longer durations. The weight of lead aprons may strain backs and wear away on knees and ankles over time. While safety apparel has improved—including being lighter weight—the burden can take its toll.

In a different realm, a study in Europe called the Healthy Cath Lab shed light on the potential consequences of long-term exposure to low levels of radiation in the cath lab. The team focused on the potential development of atherosclerosis, based on other research that suggests radiation exposure may affect endothelial function and ultimately injure the vascular system.

They looked at three biomarkers in exposed and unexposed interventional cardiologists and nurses that might flag a risk: carotid intima-media thickness, leukocyte telomere length and a DNA repair gene polymorphism. What they found were possible subclinical signs of “early and accelerated vascular aging.”

Maybe this is nothing. Even if that is the case, these kinds of studies help to raise awareness of potential occupational hazards in the cath lab and prompt discussions about preventive strategies. After all, ALARA—As Low As Reasonably Achievable—should apply to you, too.

Candace Stuart

Editor, Cardiovascular Business