I was quite surprised to notice that interventional cardiologists and other interventional medical specialties were excluded from your top nine list of most unhealthy hospital jobs (Becker’s Hospital Review, Nov. 3 issue), despite significant rates of musculoskeletal injury and constant exposure to ionizing radiation among this group of professionals.
While several medical specialties included on the list cite radiation as an occupational hazard, the data shows that interventionalists receive more radiation exposure than any other group of medical professionals. Additionally, the equipment worn to protect interventionalists from radiation exposure actually is responsible for a significant number of career-threatening orthopedic injuries.
This past April, the Organization for Occupational Radiation Safety in Interventional Fluoroscopy was launched to generate awareness of the growing issue of occupational health hazards in the fluoroscopy lab among medical specialties such as interventional cardiology, vascular surgery, electrophysiology, interventional neurology and orthopedic surgery. Concern is growing as more and more physicians and fluoroscopy lab workers become stricken with work-related health issues.
Physicians and staff in interventional labs are exposed to X-rays emitted from fluoroscopy throughout their workday. For nearly all other radiation-based diagnostic medical procedures, the medical staff exits the area of potential radiation exposure prior to the use of the radiation-emitting device. This is not the case with interventional procedures, as fluoroscopy is used to guide manipulation of devices, which has historically required the staff to stay very close to the patient and radiation source for many hours.
During these procedures, an overwhelming majority of interventionalists and their teams are typically positioned within a few feet of the X-ray source. Accordingly, interventional teams have the greatest risk of exposure to dangerous levels of ionizing radiation, and interventional cardiologists in particular have a radiation exposure rate documented to be two to 10 times higher than that of diagnostic radiologists.1
As a result of this direct, chronic exposure to ionizing radiation, there is mounting evidence that shows a link to a series of significant stochastic health effects, including left-sided brain tumors (in interventional cardiologists, 86 percent of brain tumors occur on the left side of the head, which is closest to the radiation source in the cath lab), posterior subcapsular lens changes (a precursor to cataracts), skin cancers, thyroid disease, brain disease, cardiovascular changes and neuro-degenerative diseases, among others.
In addition to the serious health risks linked directly to radiation exposure, serious and debilitating orthopedic problems have resulted from the wearing of the lead-lined personal protective equipment that is standard protocol for physicians and fluoroscopy-lab staff. The PPE causes health hazards on two fronts:
Although lead-based PPE (e.g. lead-lined aprons) is designed to significantly decrease ionizing radiation exposure to interventionalists and assisting personnel, these technologies are not ideal solutions; they are voluntary and, even when used properly, fail to protect medical personnel’s head and extremities.
The weight of the PPE has caused debilitating adverse health effects in the form of spinal and other severe musculoskeletal injuries. In fact, surveys of cath lab cardiologists show staggering rates of orthopedic health impacts associated with long-term, sustained use of heavy lead aprons while standing for prolonged periods of time to perform coronary angioplasties and other interventional procedures.
A 2004 report by the Society for Cardiovascular Angiography & Interventions showed a staggering 60 percent incidence of spine problems among interventional cardiologists with at least 21 years of work, and even those with just five years of cath lab experience have spinal problems at a rate of 26 percent. In addition to spinal issues, interventional cardiologists, especially those over the age of 35, report significant pain in the neck, back, hips, knees and ankles. Unfortunately, the associated debilitating pain contributes to increased absenteeism and in some cases, early retirement.
More recently, a 2015 study conducted by the Mayo Clinic concluded that employees who were involved in interventional procedures that use radiation reported a 67 percent increase in the prevalence of musculoskeletal pain, were more likely to have sought medical care for their pain and were more likely to have had an ergonomic evaluation.
While I’m certainly not trying to minimize the health hazards associated with other medical specialties such as those listed in your article, interventionalists can no longer take a back seat. The procedures they perform are, in many cases, life-saving . These compassionate and courageous men and women deserve our respect. It is about time that the healthcare industry takes heed and not only openly recognizes the serious health issues interventionalists face on the job each day, but works toward finding better ways to protect them.
Let’s start by adding them to the list of the Most Unhealthy Hospital Jobs.
Sincerely,
Michael D. Seymour, MS, MPH, CIH
Director of Advocacy Programs
ORSIF
1E. Picano, et al, Occupational Risks of Chronic Low Dose Radiation Exposure in Cardiac Catheterisation Laboratory: The Italian Healthy Cath Lab Study, Europea
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