“It has to be hit home on a regular basis.” “It” is the need to be aware of radiation exposure in the cath lab, and the message bearer in this case was Charles E. Chambers, MD, an interventional cardiologist who devotes time and energy promoting radiation safety.
The quotation is from an interview in 2014 for our magazine article, “Rad is Bad: Reducing Cath Lab Operators’ Exposure Risk.” Chambers, of the Penn State Hershey Heart and Vascular Institute and president of the Society for Cardiovascular Angiography and Interventions, was one of several physicians, radiologists and medical physicists who contributed to the piece by sharing details on strategies that have shown success nipping away at radiation exposure to physicians and staff during procedures in the catheterization laboratory.
The As Low As Reasonably Achievable campaign emphasizes practices that balance imaging quality with safety. The goal is to get a scan that can inform physicians using the least amount of ionizing radiation necessary. Patient safety is always a concern, but operators and staff also may be exposed to radiation during a PCI, an ablation or any number of procedures in the cath lab.
“You can’t touch radiation and the consequences aren’t tangible,” said Chambers. “Because it is less immediate than some of the other things we deal with, it is harder to put a handle on.”
The magazine article showed that labs can institute safety efforts on several fronts. Education, whether through institutional training, society initiatives or as an individual’s personal cause, raises awareness. Today’s imaging equipment offers a number of options that can reduce exposure without compromising quality as well. And then there are standard and new practices for protecting operators and staff such as wearing lead aprons, protective eyeglasses and shielding.
A team in Israel reported this month about a practice that is gaining some notice as a way to reduce occupational radiation exposure. They randomized patients at their center to be covered with a lead apron, a technique that reduces radiation scattering to operators and staff. A group from Canada had reported on their use of a similar strategy at the 2014 American College of Cardiology’s (ACC) conference.
The technique reduced exposure to operators in both studies, but the Israeli team also measured exposure to patients. Audience members at the ACC presentation had suggested that the apron might increase radiation exposure to patients, and the Israeli results showed that was the case.
The authors of that study, the presenter at the ACC and many other cardiologists have pointed out that a cath procedure is a rare event for the patient while operators and staff encounter the potential risk of exposure repeatedly over a career. Using the apron may create a small increased risk for patients and an accumulatively significant reduction in risk for cath lab personnel.
Safety advocates such as Chambers emphasize that medical professionals need to think of the long-term exposure and consequences. The lead apron is one of many options on the table. It may or may not be an ideal option, or even a good option in the end. But it opens up the discussion, which raises awareness. And that is a good thing.
Candace Stuart
Editor, Cardiovascular Business