Michael Seymour, director of Advocacy Programs for the Organization for Occupational Radiation Safety in Interventional Fluoroscopy (ORSIF), believes that there needs to be greater awareness of the dangers of radiation exposure during interventional procedures as some interventional cardiologists may not appreciate the true risks that they face in the cath lab.
How much radiation is an interventional cardiologist exposed to during their working career?
Interventional cardiologists typically have to be on the right-hand side of a patient during procedures, so their left side tends to get more exposure than the right side. I have seen some figures that suggest, during a 20-year interventional cardiology career, radiation exposure to the head is equivalent to that of 50,000 chest X-rays.
What are the available data for the effects of this radiation exposure?
The BRAIN (Brain radiation exposure and attenuation during invasive cardiology procedures) study, which was published in JACC: Cardiovascular Interventions, found that radiation exposure to interventional cardiologists is significantly higher on the left side of the head than it is to the right side of the head. This supports previous research that found a higher rate of left-sided brain tumours in interventional cardiologists.
Do you think interventional cardiologists are sufficiently aware of the risks of radiation exposure?
I think some operators have a false sense of security when they put on the lead apron—they think that wearing it fully protects them from the dangers of radiation exposure but that is not the case. A lead apron, even with thyroid collar, does not fully protect the neck, it does not protect the head, and it does not protect the eyes. In fact, about 40% of interventional physicians and about 60% of nurses and technologists experience changes to the eye associated with cataract formation from ionizing radiation. Those are outstanding numbers.
Additionally, a survey by the Society for Cardiovascular Angiography and Interventions (SCAI) indicated that about 40% of physicians regularly or routinely failed to wear their dosimeter badges. This, to me, again suggests that they think their vest is giving them all the protection they need and they do not need to pay attention to the levels of radiation they are being exposed to.
ORSIF’s aim is to raise awareness of the radiation and musculoskeletal hazards, associated with working in interventional fluoroscopy laboratories. How is it trying to achieve these aims?
We have a wealth of information on our website about the health consequences of radiation exposure and we have been talking to our physician partners, associations and allied health professional groups about the need to increase awareness among healthcare providers and professionals about these hazards. We have also published the White Paper—Occupational exposure to ionizing radiation in interventional fluoroscopy: severity of adverse effects of a growing health problem.
How do you think the risks of radiation exposure can be minimised?
Technologies are now coming onto the market that may help to reduce the risk of radiation exposure during interventional procedures. For example, there are robotic systems that enable interventional cardiologists to perform vascular procedures away from the source of the radiation. Real-time dosimeters are available as are lighter protective equipment (to lessen the risk of musculoskeletal problems that can be associated with wearing lead aprons).
ORSIF is designed to be a partnership between industry and physicians. At present, Corindus Vascular Robotics and Hansen Medical along with several interventional physicians, are current sponsors/members of ORSIF.