A new study suggests that health care provider staff could be under greater risk than previously thought, and needs to be taken into more serious consideration. Medical staff that performs fluoroscopy for heart procedures are at a greater risk for orthopedic problems, cataracts, skin lesions, and cancers. Fluoroscopy is medical imaging, where a continuous X-Ray beam is used to see real time images of certain parts of the body. It is used for heart procedures, including coronary angiography which is used to detect heart conditions, and coronary artery angioplasty which is used to widen blocked or narrowed arteries.
The findings were published in the journal Circulation: Cardiovascular Interventions by colleagues and study leader Maria Grazia Andreassi, PhD, head of the Genetics and Molecular Epidemiology Unit at National Research Council Institute of Clinical Physiology in Pisa, Italy.
Doctors, nurses, and technicians are all exposed to fluoroscopy radiation in cath labs. Andreassi notes that, of all X-Ray procedures, fluoroscopy guided heart procedures lead to the greatest radiation exposure among health care workers.
“Interventional cardiologists and electrophysiologists have a two to three higher annual exposure than that of radiologists, as they are closer to the radiological source and experience radiation exposure with the patient, whereas diagnostic radiologists are generally shielded from radiation exposure,” she explains.
Busy cardiologists and electrophysiologists are exposed to around 5 millisieverts (mSv) of radiation each year; mSv is a measure of how much radiation is absorbed by the human body.
Over thirty years, these health care workers may be exposed to around 50 to 200 mSv, which is equivalent to 2,500-10,000 chest X-rays. The researchers of the study assessed the results of an Italian survey that was completed by 746 health care workers. 466 worked in cardiac cath labs for a median of 10 years, while 280 worked in non radiation health care settings.
Those who worked in the cardiac cath labs were found to be at 7.1 times greater risk for back, neck, or knee problems, 6.3 times greater risk for cataracts, and 2.8 times greater risk for skin lesions.
As suspected, the estimated radiation exposure was highest for cardiologists and electrophysiologists.
It was found that individuals that worked in a cath lab for at least 16 years were found to have the highest risk for such conditions, and were also found to be three times more likely to develop cancer, in comparison to those in other health care related fields. They are also more likely to have high blood pressure and cholesterol, though they have relatively low rates of cardiovascular illness.
The researchers point to a number of study limitations, since radiation doses were self reported by health care professionals rather than being measured, for example. The workers also decided whether they wanted to take part in the survey or not, and it was noted that if they had pre-existing health conditions, they may have been more motivated to do so.
The study is unable to establish cause and effect between radiation exposure and health problems, but the researchers believe that their findings emphasize the need for increased focus on protecting the health of medical professionals regularly exposed to radiation, particularly cardiologists and electrophysiologists. Andreassi notes that intensive training in how to protect against radiation can significantly reduce exposure in the workplace.
“Unfortunately, cardiologists pay little heed to monthly or cumulative reports of radiation exposure,” she adds. “And recent studies confirm that simple, effective protection measures – such as a lead curtain, protection glasses and thyroid collars – are not used by the majority of exposed cardiologists.”
