28
March
2022
|
06:00
Europe/Amsterdam

What Effective Radiation and Occupational Safety in the Cardiac Catheter Laboratory Can Look Like

Cardiac catheter laboratories can be complicated workplaces on matters of occupational safety. On one hand, physicians and nursing staff work in the immediate vicinity of a radiation source. Of particular concern are areas not covered by x-ray protection, such as the eyes, head and vessels of the neck [1, 2].  Exposure to radiation can lead to serious damage, including cataracts and brain tumors [3]. On the other hand, x-ray protection garments put a strain on the musculoskeletal system due to their heavy weight. After only five years, 85 percent of physicians working in interventional settings complain of pain or damage to the spine [4]. Each additional radiation protection garment can mean more weight for staff to bear. Can this dilemma be solved?  Interventional cardiologist Dr. Mathias-Christoph Brandt, senior physician at the Salzburg University Hospital, says yes. Using the Zero-Gravity system, cathlabs can optimize radiation protection and occupational safety, as well as attract more female physicians to interventional cardiology who often report serious concerns regarding radiation exposure. 

 

A glimpse into the working environment of interventional cardiologists

Interventional cardiologists spend a large part of their working day at the catheter table, typically wearing an X-ray apron that weighs 6-10 kg. Interventions often take a long time – complex bifurcations or chronic vascular occlusions may take up to two hours, for example.

"I work mainly in the cardiac catheter laboratory, where I spend up to 90 percent of my working time. My day in the cardiac catheter laboratory starts at 7.30 am with the first cases. The core working hours actually end at 4:00 pm – but our services are often needed beyond that," reports Dr. Brandt. The range of tasks for interventional cardiologists is diverse and includes diagnostic angiographies, interventions on coronary or peripheral vessels, and transcatheter aortic valve implantations (TAVI). But there’s a downside. "We pay for our work with a high probability of damage to our health," explains Dr. Brandt.

We are seeing a worrying increase in aggressive brain tumors among interventional cardiologists who have worked in catheter laboratories for many years. These occur on the left side in 85 percent of the cases, i.e. on the side of the radiation source, and have a very poor prognosis.

Dr. Mathias-Christoph Brandt, senior physician at the Salzburg University Hospital

What risks are physicians exposed to in the cardiac catheter laboratory?

A worrying picture emerges from several studies and surveys of interventional cardiologists. Fifty percent of them have cataract precursors of the eye lens [5]. They also see a higher frequency of atherosclerosis of left-side neck vessels [2], and up to 85 percent of those examined had either spinal complaints or muscle pain [4]. The latter are certainly due to the weight of the radiation protection clothing and resulting postural damage.

"In addition, we are seeing a worrying increase in aggressive brain tumors among interventional cardiologists who have worked in catheter laboratories for many years. These occur on the left side in 85 percent of the cases, i.e. on the side of the radiation source, and have a very poor prognosis," warns Dr. Brandt. Beside the effects of increased radiation exposure and problems with the musculoskeletal system, assistants and physicians in catheter laboratories also report suffering more frequently from depression and anxiety. These may indicate a heavy workload and a lot of stress.

     

Current protection does not seem optimal

Despite the heavy weight, conventional lead aprons with thyroid protection offer insufficient protection against scattered radiation. "Lead aprons have large cutouts for the arms on both sides. However, in the catheter laboratory, we work with the left side of the body facing the radiation source, so that the radiation has a wide path through the shoulder, extending into the chest almost continuously. This is a risk for chronic radiation damage. We know that medical staff working constantly at the catheter table has a higher risk of sarcomas in the mediastinum – and female colleagues a higher risk of breast cancer," explains Dr. Brandt. In addition, the lenses of the eyes and the head are not protected by conventional lead aprons. Although lead glass goggles provide a certain amount of protection, they are usually at the wrong angle to the scattered radiation, which strikes from the left at an upward angle.

Dr. Mathias-Christoph Brandt, senior physician at the Salzburg University Hospital

That's why two years ago, the catheter team at Salzburg University Hospital introduced the Zero-Gravity system. "This system, guided by an articulated arm on a ceiling track, has a much stronger lead armor for the body. It extends down to the lower legs and is also supplemented by protectors for the shoulders and a face shield of lead impregnated acrylic that protects the eyes and head from scattered radiation," says Dr. Brandt. "And the best of all: The system is completely weightless for the examiners! As part of a scientific project, we used live dosimetry to investigate the actual level of exposure to scattered radiation for examiners and assistants in daily clinical practice. The results surprised us: They have shown how scattered radiation constantly reaches the medical staff – despite a fully equipped catheter laboratory with all established systems, such as ceiling-mounted lead shield, under-table lead protection, and patient lead pad," says Brandt and adds: "With Zero-Gravity, we measured a reduction in scattered radiation in various body areas of the examiners of up to 97 percent."

Zero-Gravity contributes to efficient occupational safety

Zero-Gravity convinced Dr. Brandt and his team that it solves two problems of classic radiation protection systems at the same time. Firstly, Zero-Gravity eliminates chronic weight load on the hips, shoulders and spine. Secondly, Zero-Gravity protects sensitive areas of the body, such as the lenses of the eyes and the chest, against radiation using the lead-acrylic glass head protection and additional reinforcement on the shoulders. A current study recently confirmed the efficient radiation protection of the system: For main operators, the scattered radiation could be reduced by more than 90 percent compared to conventional lead aprons.

"I know from daily practice that Zero-Gravity has another advantage: Thanks to the system anchored to the ceiling, as a user I only wear the protective clothing when I really need it – namely right next to the catheter table. The moment I step off the table, whether on my way to the control room or the locker room, I'm already free of the lead protection. This results in an increase in efficiency and optimization of work," adds Dr. Brandt.

I am very grateful that the University Hospital Salzburg has invested in the Zero-Gravity system. In addition to this improved radiation protection at the workplace, it has also launched health and prevention programs for employees. I know from my own experience that good occupational health and safety is extremely important. 

Dr. Mathias-Christoph Brandt

Employer attractiveness is also characterized by health prevention programs and high occupational safety standards

"We are very happy with Zero-Gravity and have really fallen in love with the system. I think that improved radiation protection and weight reduction of these systems can also help to attract more women to work in the catheter laboratory," says Dr. Brandt. Because numbers prove what is no secret in practice: Women are still underrepresented in interventional cardiology. In the United States, only 4.5 percent of interventional cardiologists are female, and only 2.8 percent of angioplasty procedures are performed by women. According to experts in the field, the physical demands and radiation exposure in the catheter laboratory are particularly challenging for female cardiologists.

Of course, good occupational safety measures and health prevention programs benefit all employees and increase a hospital’s attractiveness as an employer. "I am very grateful that the University Hospital Salzburg has invested in the Zero-Gravity system. In addition to this improved radiation protection at the workplace, it has also launched health and prevention programs for employees. I know from my own experience that good occupational health and safety is extremely important. My recommendation to all interventionalists is therefore that they too take a critical look at their workplace – there is always a need for optimization, especially when it comes to occupational safety and health protection," states Dr. Brandt.

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References:

1. Picano, E.; Vano, E.; Domenici, L.; Bottai, M. ; and Thierry-Chef, I., Cancer and non-cancer brain and eye effects of chronic low-dose ionizing radiation exposure. BMC Cancer, 2012. 12: p. 157.

2. Andreassi, M.G.; Piccaluga, E.; Gargani, L.; Sabatino, L.; Borghini, A.; Faita, F.; Bruno, R.M.; Padovani, R.; Guagliumi, G. ; and Picano, E., Subclinical carotid atherosclerosis and early vascular aging from long-term low-dose ionizing radiation exposure: a genetic, telomere, and vascular ultrasound study in cardiac catheterization laboratory staff. JACC Cardiovasc Interv, 2015. 8(4): p. 616-27.

3. Roguin, A.; Goldstein, J.; Bar, O. ; and Goldstein, J.A., Brain and neck tumors among physicians performing interventional procedures. Am J Cardiol, 2013. 111(9): p. 1368-72.

4. Klein, L.W.; Tra, Y.; Garratt, K.N.; Powell, W.; Lopez-Cruz, G.; Chambers, C.; Goldstein, J.A.; Society for Cardiovascular, A. ; and Interventions, Occupational health hazards of interventional cardiologists in the current decade: Results of the 2014 SCAI membership survey. Catheter Cardiovasc Interv, 2015. 86(5): p. 913-24.

5. Vano, E.; Kleiman, N.J.; Duran, A.; Romano-Miller, M. ; and Rehani, M.M., Radiation-associated lens opacities in catheterization personnel: results of a survey and direct assessments. J Vasc Interv Radiol, 2013. 24(2): p. 197-204.