Health care workers performing cardiovascular procedures in a cardiac catherization (cath) lab under fluoroscopy potentially have a higher chance of health issues such as cataracts, skin lesions, cancers and orthopedic illness, according to a recent study in Circulation: Cardiovascular Interventions.

The team, led by Dr. Maria Grazia Andreassi, head of the genetics and molecular epidemiology unit at the National Research Council Institute of Clinical Physiology in Pisa, Italy, surveyed workers who had an average of 10 years working in a cath lab and those who worked in other professional settings.

"We made an electronic poll through the scientific societies mailing list, but also a direct head-to-head interview with dedicated personnel during annual meetings of scientific societies in an ad-hoc space in the congress exhibition," Dr. Andreassi told HCB News.
In an associated editorial in Circulation: Cardiovascular Interventions, Drs. Lloyd W. Klein and Mugurel Bazavan, reported that a total of 746 Italian workers completed self-administered questionnaires, 466 who were exposed to radiation and 280 who were not exposed.

Drs. Klein and Bazavan noted that the results in the study also demonstrate how thyroid disease, hypertension, and anxiety/depression, were more common among staff members working in a cath lab, with a higher occurrence in physicians (69 percent) when compared to nurses (22 percent) and technicians (9 percent).

The annual exposure to radiation for experienced cardiologists and electrophysiologists is around five millisievert (mSv), which measures for radiation’s biological effects, said Dr. Andreassi. "Over a thirty-year career, that amount adds up to 50 to 200 mSv, or the equivalent of 2,500 to 10,000 chest X-rays, she added.

Compared to colleagues not exposed to radiation, cath lab workers who were exposed to radiation had 7.1 times the risk of having problems to the knee, back and neck, and were 6.8 times more like to develop cataracts.

The researchers also found that cath lab workers of 16 years or more had high rates of blood pressure and cholesterol, and were three times more likely to have cancer.

“Interventional cardiologists and electrophysiologists have a two to three times 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,” said Dr. Andreassi.

The researchers said some limitations to the study included the respondents’ choice whether or not to participate in the survey, and radiation doses were self-reported, not directly measured.

"Further studies are strongly needed and our observations must be confirmed in a larger population of cardiologists," Dr. Andreassi said, "In particular, we will focus our research on brain, eyes and reproductive effects."

Dr. Andreassi cautions that efforts concerning radiation awareness should be raised, since training in radiation protection can reduce radiation doses by a significant amount. Lead curtains, protection glasses and thyroid collars are not used by a majority of exposed cardiologists, said Dr. Andreassi.

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