Cardiologists lead push for new cath lab radiation safety standards
Several U.S. medical societies have collaborated on a new report advocating for better safety standards in the nation’s cardiac catheterization labs. The groups represent the fields of cardiology, radiology and surgery, three healthcare specialties intimately familiar with the risks associated with repeatedly performing minimally invasive procedures.
This new report is the work of the 2025 Summit on Radiation and Orthopedic Risks in Fluoroscopic Labs, which originally met to discuss cath lab safety during the SCAI 2025 Scientific Sessions meeting in Washington, D.C. The final document represents a thorough summary of that meeting as well as a call to action aimed at policymakers, physicians and other industry stakeholders who can help bring about change for the clinicians impacted by this subject on a day-to-day basis.
The Society for Cardiovascular Angiography and Interventions (SCAI), American College of Cardiology (ACC), Alliance for Cardiovascular Professionals, American Society of Echocardiography, Heart Rhythm Society, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society of Vascular and Interventional Neurology and Society for Vascular Surgery all endorsed report, which was simultaneously published in JSCAI, Heart Rhythm, JVIR and JVS–Vascular Insights.[1, 2, 3, 4]
Cath lab safety: A growing concern for cardiology groups
Cath labs regularly use real-time X-ray imaging to guide catheters and other medical devices through the blood vessels of patients. These interventional procedures help care teams evaluate, diagnose and manage patients for a wide range of conditions, helping patients avoid the trauma and risk of open surgery and bringing considerable cost savings to hospitals and health systems.
However, the interventionalists who perform these minimally invasive procedures face significant health hazards due the radiation exposure they receive over the course of their career as well as the heavy lead or lead-equivalent protective garments they wear to protect against that radiation. These safety issues have received more and more attention in recent years thanks to the advocacy of such groups as SCAI and ACC, but little has been done to actually improve the safety of U.S. cath labs. In fact, these concerns are regularly cited as one of the primary factors keeping trainees from considering a career in such fields as interventional cardiology and interventional radiology.
ALARA+: A new path forward for protecting cath lab employees
For many years now, radiation safety policies have been discussed in terms of the ALARA principle, short for “as low as reasonably achievable.” There has been a growing concern, however, that the ALARA principle does not go far enough to minimize the risks associated with performing interventional procedures. In addition, ALARA does not address the significant risks associated with wearing heavy lead or lead-equivalent protective garments in any way.
With these limitations in mind, this new report introduces the concept of ALARA+, which stands for “as low and as light as reasonably achievable.”
“ALARA+ represents a shift from accepting risk to expecting better,” SCAI President Srihari S. Naidu, MD an interventional cardiologist with Westchester Medical Center and New York Medical College, said in a statement. “Fluoroscopy-guided procedures save lives every day by allowing minimally invasive treatment for heart disease, vascular disease, and stroke. The clinicians and teams delivering that care deserve laboratories that protect them just as thoughtfully as we protect our patients. This multi-society call to action is about modernizing safety expectations, not creating new obligations. We are calling for the acceleration of practical changes in technology, policy, and laboratory design so radiation exposure is minimized, and the physical toll of protective equipment is no longer treated as inevitable.”
“These occupational harms affect every member of the procedural team and the healthcare system as a whole, carrying major financial and human costs,” added summit co-chair Arnold H. Seto, MD, MPA, chief of cardiology at Long Beach VA Medical Center, director of interventional research at the University of California, Irvine and a longtime SCAI member. “Across fluoroscopy laboratories, clinicians and staff face both cumulative radiation exposure and the physical burden of heavy protective equipment. Over time, that means years of strain from protective gear and nonergonomic lab setups. The consequences are real. People develop chronic pain, require surgery, and some are left with severe spinal conditions that limit or even end their procedural careers. Maintaining a skilled workforce in these labs, which is already in limited supply, is essential to ensuring patients have access to these lifesaving procedures. As demand for minimally invasive procedures continues to grow, protecting and retaining experienced teams will be critical to preserving and expanding access to care.”
Call to action comes as US appears to be relaxing certain radiation policies
The Trump administration has repeatedly signaled that federal radiation policies should stop using the ALARA principle as a guiding force. These efforts have been primarily focused on changes in the U.S. Department of Energy (DOE) and U.S. Nuclear Regulatory Commission (NRC), but the moves highlight the fact that cardiologists, radiologists and other healthcare providers may not necessarily be able to rely on federal support when it comes to improving cath lab safety throughout the United States.
This new report does not specifically cite these potential changes within the DOE or NRC, but it does highlight the importance of state-level advocacy when groups kick off any potential lobbying efforts.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.