SCAI pushes for better radiation protection in cath labs
The Society for Cardiovascular Angiography and Interventions (SCAI) is spearheading a new initiative to dramatically improve occupational safety in catheterization labs by pushing for the widespread adoption of next-generation radiation protection technologies. Cardiovascular Business spoke with SCAI President James B. Hermiller, Jr., MD, director of the transcatheter structural heart program at Ascension St. Vincent Heart Center in Indianapolis, in the above video about the need for change being urgent and well-documented.
"It's a really important issue. We finally figured out, from an occupational safety standpoint, that it's unsafe in the cath lab. A SCAI survey of our members was remarkable, with 50% saying they have orthopedic issues, a third had serious cervical spine issues and 5% had cancer. And this is far above what we see in a regular population. It's the heavy lead that we wear to protect ourselves from the radiation, and we really don't protect ourselves that well," Hermiller explained
SCAI’s advocacy centers on enhanced radiation protection devices (EPDs), an emerging category of technology that dramatically reduces exposure without the need for traditional, wearable lead shielding. These innovations promise not only to protect physicians, but also the entire cath lab team, including nurses, technologists and sonographers.
"There's new technology to help us address this, and we really want to allow everybody that works in a cath lab to have a chance to have these, to get much less radiation, often zero radiation," Hermiller said.
Several vendors now offer advanced EPD systems, which is why SCAI is now making efforts to require these types of systems in cath labs to address occupational safety. These include ceiling-mounted barriers, encapsulated shielding that moves with the equipment and other breakthroughs from vendors such as Rampart, Protego, Egg and Radiaction.
"These new radiation protection devices allow us to get out of the lead and yet get essentially no X-rays. Also, there's a number of new technologies. The angiography imaging systems from Phillips, GE, etc. that are really reducing the amount of radiation that comes out of the can. The trouble with it is it costs money and we've got to impress upon the administrators that the investment's important," he said.
Convincing hospitals to invest in radiation protection
This new lower-dose angiography technology and protection systems have restarted the conversation around protecting cath lab staff now that there are vastly better ways to reduce dose than the previous status quo of just wearing heavy lead aprons. SCAI is working on creating a package of information to take to hospital and health system administrators to try and convince them why investment in these technologies is important.
He said part of the strategy being developed is to get the entire heart team involved in these efforts, including different organizations, different specialties, nurses, technologists, and sonographers.
"This is for everybody in the cath lab, not just the physicians," Hermiller stressed.
Additionally, SCAI is taking advocacy efforts to Washington, D.C., to seek government legislative measures and regulatory bodies on board. However, as the physician and staffing shortages continue, Hermiller said it should not take much convincing because issues with staff orthopedic injuries can cost much more than the purchase of new equipment.
The push for new standards also comes at a time of growing awareness of long-term occupational health risks and the increasing difficulty in recruiting new clinicians and staff who are unwilling to accept the risks of working in lead for hours on end each day. As shortages of cardiologists continue to grow, there is also an acute need to retain the interventionists you have and make sure they can work longer into their careers rather than stepping down because of orthopedic and spinal issues.
"If you have a physician out for six weeks, the hospital loses a million dollars. It's also very expensive to replace nurses and technicians. And we're seeing these days in terms of recruitment, new physicians, new staff, they want to have these new technologies in the lab. They don't want to wear the lead around all day," Hermiller said.
For health systems that decide not to make these investments, he said they will be opening themselves up to litigation over safety issues.
"I do think the ultimate lever is going to be in five or six years. If your hospital won't pony up to have these in the lab and you have an injury, there's going to be a class action suit. So this is going to be a liability issue, but hopefully we're going to be able to solve this without having to pull that lever," Hermiller explained.
Beyond protecting current staff, SCAI’s initiative could help address disparities in the workplace. Radiation concerns are a major barrier for women in interventional cardiology, particularly during pregnancy.
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]