Radiation in the cath lab: Tracking state-level regulations for cardiologists
How much radiation can interventional cardiologists in the United States legally be exposed to in the cath lab? According to new research published in JSCAI, the regulations vary from one state to the next.[1]
The study’s authors hope these policies can be standardized in the future to help avoid confusion and ensure widespread adoption of advanced technologies.
“Interventional cardiologists have one of the highest rates of occupational exposure to ionizing radiation,” wrote first author Amit N. Vora, MD, MPH, an interventional cardiologist with Yale New Haven Hospital and Yale School of Medicine. “Radiation exposure is associated with higher risks of malignancy, cataracts, and other diseases, including vascular and neurocognitive aging. Although current generation fluoroscopic imaging systems and contemporary radiation practices have significantly reduced radiation exposure in procedural areas over time, there is no clear consensus on guidelines regarding exposure and protection.”
Vora et al. noted that 31 states leave radiation regulations to public health officials. In another 14 states, a department of environmental protection is tasked with making such decisions. The remaining five states have their own specific agencies.
The authors noted that all states acknowledge the federally-mandated limit of 50 mSv of annual exposure. The International Commission on Radiological Protection recommended reducing that limit to 20 mSv, they added, but “this has not been widely adopted.”
When it comes to barrier protection, 24 states require a minimum of 0.25 mm of lead equivalent shielding be worn on the job. Another 11 states require a minimum of 0.50 mm. Fifteen states, meanwhile, “specifically require the use of aprons, not just any shielding methods.”
A handful of other radiation protection policies are commonly seen throughout the United States. Forty-eight states require a single dosimeter be worn on the job, for example, and 46 states require specific training to take place. Forty-seven states require site-specific radiation safety programs.
“If the reported dose exceeds occupational limits, all states require reporting to the state authority and corrective steps to be taken under the supervision of that authority, though often there is lack of clarity with respect to the specific corrective steps,” the authors added.
Vora and colleagues noted that some groups, such as the Society for Cardiovascular Angiography & Interventions (SCAI), have started pushing for a new approach to radiation protection in the cath lab.
“Recently, professional societies have advocated working toward a ‘lead-free’ environment in the cardiac catheterization laboratory, using enhanced radiation protection devices to provide more effective whole-body protection for operators and ancillary staff and to minimize the risk of musculoskeletal and orthopedic injuries with the minimization or elimination of lead aprons,” the group wrote. “When adopting these new technologies, sites must ensure that they meet state-specific guidelines with respect to barrier protection.”
Even with this ongoing push in the works, however, the group emphasized that the “lack of standardization” creates compliance challenges for healthcare providers, especially those with practices in multiple states.
“With continued evolution of catheter-based approaches to treat a wide spectrum of cardiovascular disease, radiation protection regulations must be modernized to reflect both advancements in radiation protection technology and the persistent risks faced by interventional cardiologists, interventional radiologists, structural heart intervention imagers, electrophysiologists, neurosurgeons, orthopedic surgeons, interventional radiologists, and cardiac or vascular surgeons, radiation technologists, and registered nurses,” the group concluded. “Because most radiation regulations occur at the state level, uniformity in specific requirements and best practices may facilitate broader adoption of contemporary technologies to minimize radiation exposure among operators and staff. Greater transparency and ease of finding radiation safety regulations may also promote safety measures.”
Read the full analysis in JSCAI here.
Two recent Cardiovascular Business video interviews focused on cath lab safety are available here and here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.