(This story has been updated with a correction.)
The growth of fluoroscopic imaging in cardiovascular and orthopedic interventional procedures is raising fears that institutional safety protocols are not adequate to protect medical staff from increased health risks resulting from radiation exposure.
Emerging technological solutions are reducing those risks, but most are in early stages of development and not yet in widespread use, at least partly because of their costs.
Fluoroscopy, which uses X-ray beams, gives cardiologists, orthopedists and interventional radiologists a less-invasive way to perform procedures such as catheter insertions through the blood vessels, angiograms, stent placements and orthopedic surgery.
But experts say the long-term effects of frequent low-dose radiation exposure on medical staff who perform such procedures has never been fully examined. “We kind of take our safety for granted when we get into this profession as interventionalists,” said Dr. Charles Chambers, a professor of medicine and radiology at Penn State Milton S. Hershey Medical Center. “We know there are radiation issues.”
In the natural environment, people are exposed to an average of 3 millisieverts, or units of radiation absorption, a year. But patients undergoing barium fluoroscopy can be exposed to the same amount of millisieverts in two minutes. Over a 20-year career, an interventional cardiologist can be exposed to up to 1,000 millisieverts to the head and 100 millisieverts to the lower body, according to estimates by the International Atomic Energy Agency.
A February report by the Organization for Occupational Radiation Safety in Interventional Fluoroscopy found evidence of a link between interventional imaging procedures and adverse health effects on medical staff. It reported heightened risk for cataracts, tumors, reduced sperm production and birth defects. A 2013 study in the American Journal of Cardiology found 22 cases of physicians who developed brain tumors on the left side of their head, which the researchers said was linked to prolonged exposure to ionizing radiation in the interventional laboratory.
Standard practices to protect staff in interventional labs include limiting their length of exposure and increasing the distance between staffers and the radiation source. Another is wearing heavy lead shields during fluoroscopy.
But some say lead protective gear does not offer staffers full-body protection, leaving the head, neck and limbs exposed. And the use of heavy lead gear has discouraged some young doctors from going into imaging-related specialties out of fear that regular use of the heavy gear over many years will cause musculoskeletal problems.