For-profit and not-for-profit healthcare facilities may value the health of their cath lab employees differently. Without a clear indication of the bottom-line impact, some hospitals may be forgoing protective equipment and sacrificing the long-term health of their workers. Should the C-suite prioritize worker health when allocating investment dollars?
Ryan D. Madder, MD, section chief of interventional cardiology and medical director of the cardiac cath lab at Spectrum Health, thinks so. “There’s a pending shortage of interventional cardiologists,” he says. “We can’t afford to lose any. Administrators need to be concerned about workplace safety and longevity of these physicians.”
Charles Harr, MD, chief medical officer at WakeMed Raleigh, concurs. “Our program is built on the reputation of our cardiologists. To lose just one of them would hurt our reputation, and we would feel it financially.”
During the course of their careers, physicians who perform fluoroscopy-guided procedures accumulate radiation exposure corresponding to 2,500 to 10,000 chest X-rays. The head, which is most exposed to the fluoroscopy beam during procedures, is subject to the equivalent of 50,000 chest X-rays.
Currently, medical societies’ consensus statements focus on radiation safety for patients.6 The onus for HCP safety rests on the institution and each worker. Personal protective equipment (PPE)—leaded aprons, gloves, eye gear, etc.—are used to reduce exposure to scatter radiation from fluoroscopy. According to D.J. Sasso, BSN, MHA, CCRN, director of cardiovascular and critical care at SCL Health Lutheran Medical Center, some hospital administrators think having leaded PPE is sufficient. Interventionalists may not agree.
There has been growing awareness of the deleterious effects of chronic exposure to fluoroscopy owing to clinical trial results and presentations at medical meetings. After being approached by interventional cardiologists at WakeMed, Harr and colleagues took a methodical approach to addressing the problem. They optimized existing imaging equipment, evaluated lighter-weight PPE and began rotating nursing and technical staff. A strategic review of imaging systems also is planned.
“Those first efforts didn’t go far enough, particularly to protect our physicians,” Harr says. “We needed to do more. Physicians are our biggest investment. They’re the ones who bring in the patients. They’re the ones who have the reputation in the community.”
Advanced solutions, including suspended lead suits and robotic systems, address the dual health challenges faced in the cath lab: exposure to scatter radiation and orthopedic injury. The Zero-Gravity suit is suspended from a floor unit or the ceiling. The physician steps inside the suit and can perform procedures without the weight of the 1.0 mm lead on his or her shoulders. The CorPath GRX System (Corindus) includes a shielded cockpit from which the specialist directs a robotic drive that manipulates interventional devices to revascularize occluded vessels.
An economic analysis conducted by the Organization for Occupational Radiation Safety in Interventional Fluoroscopy (ORSIF) estimated that eight interventional HCPs will develop fluoroscopy-related cancer each year.7 ORSIF projects a higher incidence of orthopedic injury, stemming from the strain that PPE places on the musculoskeletal system, as roughly half of interventional physicians have at least one orthopedic injury during their career.8 ORSIF estimates the an-nual economic cost of musculoskeletal disorders at $12.2 million for cath lab HCPs in the U.S.9
The amount that an organization is willing to invest to avoid occupational cath lab health hazards varies. “Not-for-profit and for-profit organizations can perceive the value of protection differently,” Sasso says. “I was more successful in purchasing Zero-Gravity protection for cardiologists at my current not-for-profit facility compared to a former for-profit hospital.”
Some hospitals may not adequately account for physician revenue generation and replacement costs. An interventional physician generates approximately $2.4 million in annual revenue, and it costs more than $1 million to replace these specialists.10,11 With the expected increase in minimally invasive procedures and the pending shortage of interventionalists, the math might work out in favor of systems that protect these physicians and extend their careers.
“Several years ago, Spectrum Health felt the economic impact of having a physician out for back surgery,” Madder explains. “This strengthened the hospital’s willingness to invest in safety.” Spectrum Health installed a CorPath robot, Zero-Gravity suits and portable, leaded shields in its cath labs to protect its HCPs.
“Purchasing a robot demonstrated our support of our cardiologists,” adds Harr. “It helped us create alignment with our cardiologists.”
Michael Seymour, MS, MPH, CIH, is the Director of Advocacy Programs at ORSIF, the Organization for Occupational Radiation Safety in Interventional Fluoroscopy. ORSIF raises awareness of the health risks of occupational ionizing radiation exposures and associated musculoskeletal risks occurring in interventional fluoroscopy laboratories. ORSIF develops sup port for medical professionals and hospi tals for new and better ways to create the safest possible work environment for those dedicated to the wellness of others.
To find out more about the economic impacts of HCP exposure to interventional fluoroscopy, visit www.orsif.org.
- Picano E, Vano E, Domenici L, Bottai M, Theirry-Chef I. Cancer and non-cancer brain and eye effects of chronic low-dose ionizing radiation exposure. BMC Cancer 2012;12:157.
- Roguin A, Goldstein J, Bar O. Brain tumours among interventional cardiologists: a cause for alarm? Report of four new cases from two cities and a review of the literature. EuroIntervention 2012;7:1081-6.
- Roguin A. Healthy interventional cardiologists—call for action. Presentation at ICI annual meeting, December 14, 2015, Tel Aviv, Israel.
- 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.
- Marazziti D, Tomaiuolo F, Dell’Osso L, Demi V, et al. Neuropsychological testing in interventional cardiology staff after long-term exposure to ionizing radiation. J Int Neuropsychol Soc 2015;21:670-9.
- Hirshfeld JW Jr, Ferrari VA, Bengel FM, et al. 2018 ACC/HRS/NASCI/SCAI SCCT expert consensus document on optimal use of ionizing radiation in cardiovascular imaging—best practices for safety and effectiveness, part 2: radiological equipment operating, dose-sparing methodologies, patient and medical personnel protection. J Am Coll Cardiol 2018;71:2829-55.
- Organization for Occupational Radiation Safety in Interventional Fluoroscopy (ORSIF). Economic impacts of radiation exposures associated with interventional fluoroscopy. July 2018.
- Klein LW, Tra Y, Garratt KN, Powell W, et al. Occupational health hazards of interventional cardiologists in the current decade: results of the 2014 SCAI membership survey. Catheter Cardiovasc Interv 2015;86:913-24.
- ORSIF. Economic impacts of radiation exposures associated with interventional fluoroscopy. July 2018.
- Merritt Hawkins. 2016 physician inpatient/outpatient revenue survey.
- Shanafelt T, Goh, J, Sinsky, C. The business case for investing in physician well-being. JAMA Intern Med 2017;177:1826-32.