Six leading US healthcare societies have jointly endorsed an expert consensus statement, calling for cath lab professionals to have greater protection from preventable radiation exposure and orthopaedic injuries associated with their jobs.
Published in the Journal of the Society for Cardiovascular Angiography & Interventions (JSCAI), the Journal of Vascular and Interventional Radiology (JVIR), and JACC: Cardiovascular Interventions, the expert consensus statement calls for hospitals, manufacturers, regulators, and professional societies to immediately adopt enhanced radiation protection technologies, modernise radiation safety standards, and strengthen monitoring and reporting practices to better protect the healthcare teams working in fluoroscopy laboratories.
Given the availability of safer technologies, the authors say broader implementation of enhanced radiation protection devices (ERPDs) is both an ethical responsibility and a necessary evolution of ALARA—As Low As Reasonably Achievable—the longstanding radiation safety standard that exposures should be kept “as low as reasonably achievable.”
“For decades, we accepted occupational radiation exposure and the physical burden of heavy protective equipment as unavoidable realities of working in a fluoroscopy laboratory,” said David G Rizik (HonorHealth Research Institute, Scottsdale, USA), chair of the writing group. “That is no longer acceptable. Technologies available today can greatly reduce radiation exposure while also addressing the orthopaedic injuries associated with traditional lead protection. The question is no longer whether these solutions exist. It is whether we are willing to make protecting healthcare workers the priority it deserves. This consensus makes clear that the time for implementation is now.”
ERPDs reduce radiation exposure through engineering controls rather than relying primarily on personal protective equipment. The consensus statement cites evidence that ERPDs can reduce operator and staff radiation exposure by up to 99%.
The statement cited a 2023 Society for Cardiovascular Angiography & Interventions (SCAI) survey of interventional cardiologists, which found that nearly 60% reported orthopaedic injuries and 17% reported limiting their time in the cath lab to reduce radiation exposure. Among women respondents, 28% reported being discouraged from working in the cath lab because of pregnancy or considering pregnancy, while 71% wanted the option to step away from the cath lab during pregnancy.
“Every clinician and staff member who leaves the fluoroscopy laboratory because of preventable injury or chronic occupational disease represents a loss of expertise that patients depend on, in addition to the immense pain and loss experienced by the clinician and their loved ones,” said James B Hermiller (St Vincent Heart Center of Indiana, Indianapolis, USA), co-chair of the writing group. “Demand for minimally invasive procedures continues to grow, and the duration and complexity of these procedures are increasing. Maintaining a healthy, experienced workforce will be essential to ensuring patients continue to have access to the lifesaving care these teams provide.”
The multisociety expert consensus statement is endorsed by SCAI, the American College of Cardiology (ACC), the American Society of Echocardiography (ASE), the Heart Rhythm Society (HRS), the Society of Interventional Radiology (SIR), and the Society for Vascular Surgery (SVS).
“Our goal is to ensure the best outcomes for patients as well as for the healthcare team that is operating within the fluoroscopy lab. Today’s enhanced radiation protection systems give us a clear opportunity to align policy, technology, and clinical practice around a safer standard. From healthcare systems to manufacturers, state legislatures and regulators, we all have a role in making sure these protections become part of the infrastructure used to deliver interventional care. This will ensure continued growth and access for these essential procedures,” said SCAI President J Dawn Abbott (Brown Medical School, Providence, USA).
