Cardiologist became paralyzed after wearing heavy aprons in the cath lab for decades—but he fought back
Interventional cardiologist Dean Kereiakes, MD, president of The Christ Hospital Heart and Vascular Institute, medical director of The Christ Hospital Research Institute and professor of clinical medicine at The Ohio State University, has long been recognized for his groundbreaking work in cardiovascular research and intervention. In 2024, however, his career—and his life—were permanently altered when decades of wearing heavy lead protection in the cath lab left him paralyzed.
Kereiakes shared his experience with Cardiovascular Business, highlighting the little-discussed issue of interventional cardiologists experiencing long-term orthopedic damage from years of wearing lead radiation protective aprons during physically demanding procedures.
Radiation exposure is a major safety concern in cath labs and the reason cath lab staff wear heavy lead aprons to protect against the risk of cancer. However, a survey of Society for Cardiovascular Angiography and Interventions (SCAI) members found that 6% reported a diagnosis of cancer and 66% reported musculoskeletal pain attributed to wearing lead. Also, 25% reported cervical spine injuries and 34% reported lumbar spine injuries. In most cases, SCAI said, the spine and other orthopedic issues can become debilitating and lead to an early retirement for many interventional cardiologists.
Speaking with Cardiovascular Business, Kereiakes discussed his history of injuries that seem to all be connected to his time in the cath lab.
"I entered a big-volume practice in 1985, and in January 1991, I had an emergency lumbosacral disc, L4, L5, and I had no movement. I fell out of bed because I had a foot drop and was taken by ambulance, where I had an emergency discectomy. I'm back in the lab within about three weeks with a foot drop. But I didn't let that stop me," he said.
Kereiakes has also battled nerve issues over the years, he explained.
"I've always had sciatica, nerve pain either down the shoulder, muscle wasting in the hand. Sometimes it would be so bad with paravertebral muscle spasm that I can't stand up straight. But I'd take prednisone 30 milligrams a day for a couple of days, taper it off over two weeks and I'd be back in the lab full go," he said.
The orthopedic pain became catastrophic on Feb. 3, 2024. After a full day of performing eight cardiac procedures, he began feeling an unusual pain in his upper back and a strange weakness in his arms. He brushed it off as just another back pain flare-up and took prednisone. The next day, however, he could not sign a dinner check, so he had to have his wife sign it. By Monday morning, he had right foot drop. Then his arms failed him entirely.
His arms began to contract into what he referred to as a "praying mantis pose." He felt like he was going to fall down. He couldn't stand up, so he laid down and yelled for his wife to call an ambulance just after 5 a.m. The hospital performed a CT scan and it quickly became clear he had a lot of damage in his spine.
"I didn't realize that I was becoming a quadriplegic, but they called the neurosurgeon and they understood very quickly. So I'm rushed down to the OR at about 6 a.m. and had a posterior decompression where they just basically unzip you and fused everything in my entire cervical spine," Kereiakes explained.
It was the start of a month-long stay in the hospital.
"You don't realize how much you take for granted your basic bodily functions until they're taken away from you. You can't walk, you can't write. I came out of there with a paralyzed right leg, paralyzed right hand, and it took me about five weeks to have the bladder function return, and until then I was getting catheterized. I know this is not a polite lunch talk, but let me tell you: these things can happen to anybody," he said.
The experience took a lot out of him, but he still had a burning passion for interventional cardiology; he would not allow himself to walk away and retire.
"I just couldn't be stopped," he said. "I know what I love to do. I have done somewhere close to 30,000 procedures."
The Christ Hospital worked with Kereiakes to create six lead-free cath labs, allowing him to continue practice on a limited schedule. They installed EggNest radiation protection systems on the patient tables, which can reduce dose to operators and staff by up to 99%, and are looking at install these systems in another six labs in the coming year.
Looking at lab safety from a hospital liability standpoint
SCAI was already working on advocacy measures to push for radiation exposure reduction in cath labs by asking hospitals to adopt newer generating radiation barrier technologies. But Kereiakes' story pushed the sense of urgency on this effort and spurred a lot of discussion among its members. SCAI changed course and is now advocating for hospitals to invest in better radiation protection solutions that could help limit the use of lead. In addition, the organization is now pushing the idea that hospitals should be liable for staff orthopedic injuries is they do not react to this urgent situation and adopt these technologies.
This is a major change in the attitudes of interventional cardiologists, who have often just accepted these risks as "part of the job." SCAI leadership is even looking at asking policymakers to adopt new regulations requiring better radiation protection systems in the cath lab.
"This has been transformational, the concept of shielding the machine rather than all the humans running around. This is an issue of workplace safety and, frankly, liability for every hospital in America. If this were Ford or GM, they would shut you down if you had even half that incidence a spinal illness, 30%. There is no profession in America that allows that. So the fact that it's 60% is even wilder," Kereiakes explained.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]