• Occupational Hazards in the Cath Lab: Cataracts, Aches, HTN Working conditions not advancing alongside device technology, cardiologists say

    Catheterization laboratory personnel report worse health conditions the longer they work there, an Italian survey affirmed.

    After working for a median of 10 years around radiation in the cath lab, staff members were more likely to have skin lesions (8.6% versus 2.0%, P=0.002); orthopedic problems of the back, neck, or knees (30.2% versus 5.4%, P<0.001); and cataracts (4.7% versus 0.7%, P=0.003) than were colleagues outside the cath lab.

    Each risk showed a “clear gradient,” rising with longer work history of greater than 16 years, Maria Grazia Andreassi, MSc, PhD, of CNR Institute of Clinical Physiology in Italy, and colleagues reported online in Circulation: Cardiovascular Interventions.

    Radiation-exposed cath lab personnel also had elevated rates of hypertension (12.9% versus 7.5%, P=0.02) and hypercholesterolemia (12.0% versus 4.0%, P<0.001), although no difference was seen in the rate of cardiovascular events.

    Physicians were at greater risk than technicians and nurses surveyed. Highly radiation-exposed physicians were at greater risk for hypertension (odds ratio [OR] 1.7, 95% confidence interval [CI] 1-3), hypercholesterolemia (OR 2.9, 95% CI 1-5), and cataracts (OR 9.0, 95% CI 2-41) than their unexposed coworkers.

    However, the trend for higher risk of cancer in these operators did not reach statistical significance (OR 4.5, 95% CI 0.9-25).

    “Health problems are more frequently observed in workers performing fluoroscopically-guided cardiovascular procedures than in unexposed controls, raising the need to spread the culture of safety in the cath laboratory,” the researchers concluded.

    Until more conclusive evidence from larger trials come to light, “every effort should be made” to raise radiation awareness in interventional cardiologists and cardiac electrophysiologists, “promoting justification of the examination, optimization of the dose, and maximal protection of the radiation workers,” they added.

    Yet according to Lloyd W. Klein, MD, and Mugurel Bazavan, MD, both of Advocate Illinois Masonic Medical Center in Chicago, “there has been almost no substantial modification in cath lab design and little change in the incidence of injury to personnel” in recent decades. Klein previously called for higher safety standards in an opinion piece in MedPage Today.

    “There is now more than enough information for us to conclude that the interventional catheterization laboratory is not a healthy workplace,” the pair wrote in an accompanying editorial.

    “So the question must be raised: why has there not been notable invention, cath laboratory design innovation, or creative approaches in personnel protection, whereas the progress made in the technology of our instruments, used within the same space, has been revolutionary?”

    Profitability appeared to be the root of the problem. “With each part of a hospital being run as a separate business entity,” the editorialists suggested, “keeping costs and salaries low and revenue high is the hallmark of good administration, much to the detriment of the skilled people who must work long hours, perform heavy physical labor, be exposed to radiation, and wear bulky personal protection.”

    The pair added that the breakneck speed of changing technology — coupled with a revolving door of young physicians ready to replace older generations — make the situation all the harder to fix: “Certainly, investing money in an innovative cath laboratory design to protect its workers is hardly cost effective when nurturing a long career is not the goal of management.”

    “We call on industry and hospital administration to provide responsible stewardship, and for physician societies and interventional leaders to advocate visibly and set new priorities, so that those of us who choose to help patients live a longer and healthier life can ourselves enjoy a long and healthy career,” they emphasized.

    Andreassi’s study included 746 Italian healthcare workers who voluntarily filled out questionnaires describing their lifestyle, work-related information, and health status.

    The exposed group included interventional cardiologists, electrophysiologists, nurses, and technicians, a cohort that showed higher rates of thyroid disease (7.5% versus 3.6%, P=0.03) and anxiety or depression (12.4% versus 2.1%, P<0.001) when compared with professionals outside the cath lab.

    Psychological ailments may reflect high stress and mental strain posed by the work of the interventionalist — or radiation itself, Andreassi and colleagues commented.

    While there is limited data regarding radiation-induced cancer, Andreassi and colleagues cited evidence that interventional cardiologists have higher levels of chromosomal damage than their clinical counterparts. In addition, tumors are more typically found on the left side of the brain, which is less shielded from radiation in the cath lab.

    Nonetheless, the group acknowledged that their questionnaire study could have been skewed by potential selection bias, “with a possible disproportionate contribution of respondents with existing health issues, who may reasonably think that their complaints are occupationally related, whereas those without medical issues may be less inclined to participate.”

    Having to rely on self-reported dose exposure numbers was also “unavoidable” because regularly wearing dosimeters has not been standard practice, they added.

    Indeed, the investigators suggested that “a diligent radioprotection habit” may negatively affect workers who are forced from the cath lab when their dosimeters alert to a certain level of exposure, thereby punishing them for wearing their dosimeters in the first place.

    That in itself shows that “rather than directly confront the issue, physicians become part of the problem,” according to Klein and Bazavan. “Accepting the risks as part of a self-deceptive bargain should not be necessary.”


    Andreassi, Klein, and Bazavan reported no relevant relationships with industry.


    Circulation: Cardiovascular Interventions


    Andreassi MG, et al “Occupational health risks in cardiac catheterization laboratory workers” Circ Cardiovasc Interv 2016; DOI: 10.1161/CIRCINTERVENTIONS.115.003273.


    Circulation: Cardiovascular Interventions


    Klein LW, et al “The economic imperatives underlying the occupational health hazards of the cardiac catheterization laboratory” Circ Cardiovasc Interv 2016; DOI: 10.1161/CIRCINTERVENTIONS.116.003742.

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