Cardiac Catheterization Laboratory Workers Face Occupational Health Risks From Chronic Radiation Exposure Interview with:
Dr. Maria Grazia Andreassi, PhD
Director, Genetics Research Unit,
CNR Institute of Clinical Physiology
Pisa, Italy What is the background for this study?

Response: Over the last 20 years, advances in imaging technology have led to an explosive growth and performance of fluoroscopically-guided cardiovascular procedures, highly effective and often life-saving. However, these procedures requires substantial radiation exposure (e.g. the average effective radiation dose for a percutaneous coronary intervention or an ablation procedure is about 15 mSv, equal to 750 chest x-rays or ~6 years of background radiation) to patients and staff, especially interventional cardiologists and electrophysiologists.

In fact, interventional cardiologists and electrophysiologists needs to operate near the patient and the radiation source and accumulate significant lifetime radiation exposure over a long career. The potential hazards of cumulative radiation exposure are the risk of cataract development and cancer induction. Anyway, there is now growing evidence in scientific community of an excess risk for other non-cancer disease even at moderate and low dose levels of ionizing radiation exposure, especially cardiovascular disease and cognitive effects. However, the characterization of health risks of accumulated low-dose radiation is incomplete and largely lacking.

Therefore, the purpose of our study was to examine the prevalence of health problems among personnel staff working in interventional cardiology/cardiac electrophysiology and correlate them with the length of occupational radiation exposure. What are the main findings?

Response: Our study reports detailed occupational health risks mostly related to work activity and radiation exposure such as orthopedic illnesses, cataract and cancers, particularly in workers with longer duration of occupational work. In addition, we found an increased prevalence of anxiety/depression, hypertension and hypercholesterolemia, supporting the recent evidence of other radiogenic non-cancer effects. What should clinicians and patients take away from your report?

Response: Our findings can contribute to spread the culture of safety making laboratories a safer place for patients and staff. At a technical level, it is important to use available dose reduction technologies and be aware of the many factors modulating radiation dose. Techniques that reduce patient dose will result in a proportional decrease in scatter dose to the operator, reducing occupational dose. Adequate radiation protection training and diligent protec­tion are also fundamental to reduce occupational exposure. The director of the Cath Lab should oversee the use of proper, well-maintained equipment and provide guidelines for the staff radioprotection. Therefore, every effort should be made to raise the radiation awareness in both patients and the professional communities of interventional cardiology/cardiac electrophysiology, promoting justification of the exam, optimization of the dose, and maximal protection of the radiation worker. What recommendations do you have for future research as a result of this study?

Response: Larger studies are certainly needed to better define the relationship between occupational radiation exposure and clinical risks. Further data will soon be available from the large “One Million Workers Study” which aims to define the health risks of protracted low dose exposure to ionizing radiation in a U.S. population of radiation workers with lifetime dosimetry, including medical and non-medical such as nuclear power plant workers and atomic veterans. Furthermore, further studies should to be also designed to assess clinical and subclinical endpoints, as well as biomarkers, since this information is more likely to lead to insights into the effects of low-to-moderate radiation exposure, as well of their prevention and treatment as suggested by UNSCEAR 2008. . Is there anything else you would like to add?

Response: A smart cardiologist cannot be afraid of the essential and often life-saving use of medical radiation, but must be very afraid of radiation negligence or unawareness as expressed by the words of Picano and colleagues in the  position document from the European Society of Cardiology (Eur Heart J 2014).


Occupational Health Risks in Cardiac Catheterization Laboratory Workers

Maria Grazia Andreassi, Emanuela Piccaluga, Giulio Guagliumi, Maurizio Del Greco, Fiorenzo Gaita, and Eugenio Picano

Circ Cardiovasc Interv. 2016;9:e003273 originally published April 12, 2016, doi:10.1161/CIRCINTERVENTIONS.115.003273




1 thought on “Cardiac Catheterization Laboratory Workers Face Occupational Health Risks From Chronic Radiation Exposure

  1. Data on risk published where? My cardiologist says’ everyone knows that cardiologists do not get cancer’. Check radiation hormesis literature for explanation.

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