Interventional cardiologists endure unique physical demands that can predispose them to occupational health hazards that are not always seen in other medical disciplines. Studies have shown that interventional cardiologists and staff are often exposed to radiation, which can lead to the development of cancers and cataracts. In addition, orthopedic injuries involving the spine, hips, knees, and ankles can occur for a myriad of reasons, including the weight of personal protective lead aprons that are worn to reduce radiation risks.
About a decade ago, a survey of interventional cardiologists showed that orthopedic illnesses were relatively common, with a strong correlation being demonstrated between the frequency of orthopedic problems and years of practice. Spine complaints and other orthopedic issues have also been linked to annual procedural volume. Cases of cancers and cataracts were also seen among interventional cardiologists and staff.
“Since that survey was completed, the duration and complexity of interventional procedures have markedly increased,” says Lloyd W. Klein, MD, FSCAI. “With rates of PCI and other interventional cardiology procedures on the rise, it’s important to reassess operator risks and consider steps toward improving the work environment.”
For a study published in Catheterization and Cardiovascular Interventions, Dr. Klein and colleagues surveyed active practicing members of the Society for Cardiovascular Angiography and Interventions (SCAI) to characterize the prevalence of occupational health problems among interventional cardiologists. The survey recorded data about members’ age, years of practice, and diagnostic and interventional cases per year. Questions focused on orthopedic and radiation-associated problems.
A Persisting Problem
Of the 314 SCAI members who responded to the survey, most tended to be busy and experienced, according to the study. At least one orthopedic injury was suffered by 49% of respondents, a finding that significantly correlated with age and annual case volume (Table). More than half of orthopedic injuries were related to back problems while about 20% involved other joints. The prevalence of orthopedic problems was higher than it was a decade ago, but fewer operators were missing work. This suggests that many are working despite having injuries, which in turn can increase risks for poor patient outcomes.
Results also showed that there was a small but substantial incidence of radiation-induced illnesses, including cancer, and suggest a nonsignificant trend with age. Nearly 7% of operators reported needing to limit the number of procedures they perform due to radiation exposure, and slightly more than 9% had to take a health-related period of absence. The incidence of radiation-related conditions, including skin injuries, cataracts, and hematologic and cancerous diseases, were all within the 5% range.
“Our findings were consistent with results from the 2004 SCAI survey and further illustrate the substantial prevalence of orthopedic complications with no real improvements,” says Dr. Klein. “The findings were also consistent with reports linking occupational radiation exposure to cancers and cataracts. We clearly haven’t done enough over the past decade to better safeguard operators from these important health issues.”
SCAI and other societies emphasize the use of personal dosimeters to monitor radiation exposure to the head, neck, and eyes. The survey by Dr. Klein and colleagues suggests that use of these protective devices is less than optimal. More than 18% of respondents reported occasionally failing to wear a personal dosimeter badge and nearly 29% reported never wearing one.
A Challenging Issue
With interventional cardiology practices continuing to evolve, there have been increases in procedural case volumes, case complexity, and patient difficulty. “Radial artery access for PCI, for example, has been widely adopted by invasive cardiologists, but this approach can increase procedural time and operator radiation exposure,” Dr. Klein says. “The development of percutaneous, non-surgical devices for treating cardiac ailments has created longer, radiation-intense procedures that were nonexistent a decade ago.”
SCAI and other societies stress the importance of adhering to regulations and practices that can ameliorate occupational hazards. “Interventional cardiologists and cath lab staff need to collaborate with administrations and other stakeholders to make health and safety a top priority for them as well as their patients,” says Dr. Klein. “Our findings show that there is a real need to address workplace safety, much like how line workers would receive help from their union representatives if it was found that they worked in unsafe environments.”
Significant efforts are needed to reduce risks of injury in operators and staff, according to Dr. Klein. “Interventional cardiologists and hospitals should think about how new cath labs should be designed in the future and consider safety a greater priority,” he says. “We need to collaborate with developers of technology that can enhance the safety of operators and staff. We have an opportunity to reduce risks associated with delivering interventional therapies by continuing to develop safer equipment and shields and by educating operators and their staff to consistently practice occupational safety. These are important initiatives because we can’t simply replace interventional cardiologists when they get injured at work.”
Lloyd W. Klein, MD, FSCAI, is a Professor of Medicine at Rush Medical College.
Lloyd W. Klein, MD, FSCAI, has indicated to Physician’s Weekly that he has or has had no financial interests to report.
Readings & Resources (click to view)
Klein LW, Tra Y, Garratt KN, et al; on behalf of the Society for Cardiovascular Angiography and Interventions. Occupational health hazards of interventional cardiologists in the current decade: results of the 2014 SCAI membership survey. Catheter Cardiovasc Interv. 2015 Mar 24 [Epub ahead of print]. Available at: http://onlinelibrary.wiley.com/doi/10.1002/ccd.25927/abstract.
Klein LW, Miller DL, Balter S, et al. Occupational health hazards in the interventional laboratory: Time for a safer environment. Catheter Cardiovasc Interv. 2009;73:432-438.
Miller DL, Klein LW, Balter S, et al. Special communication–occupational health hazards in the interventional laboratory: Progress report of the multispecialty occupational health group. J Am Coll Radiol. 2010;7:679-683.