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Interventional cardiologists take our responsibility to improve patient quality of life and increase the likelihood of survival in heart diseases seriously, and we are willing to accept personal risk to practice our profession. Perhaps this is why, for the past 30 years or so, interventionalists never made a fuss about the health problems we face as a result of our work in fluoroscopy labs.
It's not that this issue didn't exist in the past. In fact, the question of how radiation might negatively affect physicians has been well documented for decades. Even when I was a medical student, it was a known fact that radiologists developed fluoroscopy-related illnesses such as leukemia, thyroid disease and cataracts at a higher incidence than others. Lead shielding was developed to obviate this concern.
What began to raise my awareness of this issue as a cardiology fellow was the extremely heavy and burdensome lead shielding I had to wear to protect myself from radiation exposure. After a couple of cases in the cath lab, my neck and back would hurt all day long! Yet, in the past, when younger physicians tried to discuss this problem with the older physicians, their attitude, to a large extent, was that if working in these conditions really bothered you, then you were entering the wrong field.
About 5 or 10 years after becoming a physician, I began to notice work absenteeism among my colleagues from back and neck problems as a result of wearing the standard heavy lead aprons and other protective gear. And, people began talking about the issue among colleagues; it was not an objective conversation, but more like, "I think we have a problem" kind of thing.
The doors began opening further about 10 years ago with a survey conducted by SCAI (). It revealed that 40% of physicians who were active in the cath lab were having these kinds of occupational issues. For me and many of my colleagues, that number was mind-blowing, but it allowed all of us to start talking about occupational health concerns more freely. You were no longer labeled a "cry-baby" if you were talking about this issue. By then, a number of prominent, high-profile interventional cardiologists developed lethal diseases linked to radiation exposure. As time went on, my peers realized that this was something we needed to talk about.
Today, occupational health hazards in the cath lab are a serious issue, from the perspectives of resource allocation, manpower management and the human toll it has taken. I know of physicians in my community who have died of brain cancers and developed leukemia. Others have developed early cataracts and some have retired early or left the lab because of neck and back issues.
And now, ten years later, a follow-up SCAI survey reveals that almost half of interventional cardiologists have suffered at least one orthopedic injury as a result of their work in the cath lab, nearly 7% have had to limit the number of procedures they perform due to radiation exposure and almost 9% have taken a health-related period of absence.
Hospitals and practices are not doing enough to protect physicians and fluoroscopy lab staff, but this is something that may not be on their radar. When I was a young doctor, management simply replaced older cath lab physicians who could no longer perform their jobs with younger ones.
Today, however, we've reached the point of such complexity, both technically and technologically, that it's just not that easy to replace the more experienced interventionalists with younger, less experienced ones. And as technology advances and steep learning curves are identified for many procedures, the old idea that we are easily replaceable is not tenable as a business strategy.
Organizations like ORSIF – – are doing their part to generate widespread awareness of the issue of occupational health hazards related to chronic, low-level exposure to fluoroscopy.
Physicians need to take a stand. We have to speak up with administrators and tell them about this problem. We must help to find and develop new techniques and methods of protection, and perhaps innovative cath lab designs, to redefine the best way to practice.
I believe that a generation from now, interventional procedures will be performed differently, in a way that takes the health of the physician as well as the patient into account.
is Professor of Medicine, Rush Medical College in Chicago, and Director, Clinical Cardiology Associates in Chicago and Melrose Park, Ill. He is also a member of the Organization for Occupational Radiation Safety in Interventional Fluoroscopy.
From the American Heart Association: