Distinct Occupational Health Hazards From Fluoroscopically Guided Procedures

A position paper regarding increased exposure to x-rays experienced by clinicians performing fluoroscopically guided procedures was published in Catheterization & Cardiovascular Interventions on behalf of members of the Joint Inter-Society Task Force on Occupational Hazards in the Interventional Laboratory.

The advent of fluoroscopically guided procedures some 30 years ago has resulted in increased exposure to x-rays which predisposes clinicians performing these procedures to definite occupational health hazards. In addition to the well-established risk for radiation exposure in recent years other consequences, such as physical stress and predilection to orthopedic injuries, have become clearer.

The burdensome personal protective equipment and the poor ergonomic design of fluoroscopic equipment and procedure rooms have been associated with increased risk for orthopedic injury, particularly related with the spine. A survey in 2004 by the Society of Cardiac Angiography and Interventions found that nearly half of respondents reported spine problems, which was much higher than the general population in the United States (27.4%).

In addition, despite improvements to both equipment and awareness, a busy interventionalist can frequently approach or exceed radiation limits that were previously believed as acceptable.

Recent reports reaffirmed the Linear-No-Threshold model for solid cancer risk and radiation exposure, indicating that risk rises linearly with increasing dose. During fluoroscopically guided procedures, the brain is the least protected organ. Recent anecdotal reports of the rate of brain and hematologic cancers among clinicians in the field have been found to be alarming by the authors.

Due to the long-understood potential harm from radiation exposure, the As Low As Reasonably Achievable (ALARA) policy was established. The position authors posed the question: What do “low” or “reasonably achievable” mean in practice? The National Council on Radiation Protection and Measurements established the maximum permissible doses by setting numerical values equal to risks for “safe,” non-radiological occupations. To that end, most radiation protection programs alert an individual when their badge readings exceed 10% and 30% maximum permissible doses.

The position authors closed out their statement with a call to action. They stated that additional research about the occupational hazards for clinicians performing fluoroscopically guided procedures is needed. These studies should address the incidence rates of orthopedic injury and radiation-associated harms, the aspects of the working environment that contribute to orthopedic problems, which radiation-induced diseases clinicians be aware of, and the clinician- or workplace-specific aspects that contribute to increased risk.

With regard to governing agencies, professional societies, and workplaces, the authors ask why there has been little improvement in workplace safety over the last 30 years. The authors stated that it is unclear what entity should be responsible for improving workplace safety and if laboratory equipment can be improved, who should cover the cost?

 “Our profession has numerous members who retired early or became seriously ill as a direct consequence of the interventional laboratory environment in which we work,” the study authors wrote. “It is time that the interventional community began working with industry to take a fresh look at laboratory design, leaving no innovation unconsidered, and that this endeavor be undertaken at the highest levels.”

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Klein LW, Miller DL, Balter S, et al. Occupational health hazards in the interventional laboratory: time for a safer environment. Catheter Cardiovasc Interv. Published online January 4, 2018. doi:10.1002/ccd.21772