STEMI cases bring high doses of radiation to the cath lab
A small number of high-dose procedures in the cardiac catheterization lab account for a disproportionate share of cumulative radiation exposure to physicians and staff, according to a study published in JSCAI and presented at TCT 2025 in San Francisco.[1]
The findings suggest that focusing radiation safety efforts on these outlier cases, especially ST-elevation myocardial infarction (STEMI) procedures, could have a large impact on clinician safety.
Ryan Madder, MD, program director of the interventional cardiology fellowship at William Beaumont University Hospital, Corewell Health East, said the motivation for the study stemmed from growing concerns about the long-term effects of radiation exposure in the cath lab.
“There has been a huge interest over the last decade trying to make the cath lab a safer place to work, because we're exposed to high levels of radiation over our entire careers. And when we think about the dangers of radiation exposure over one's career, it's the cumulative dose that matters,” Madder explained in a video interview with Cardiovascular Business.
Co-author Michael Abiragi, MD, a cardiology fellow at the Frederik Meijer Heart and Vascular Institute, Corewell Health West, said the study looked at 363 consecutive cases in two cath labs. These were ranked them from one to 363 based on radiation dose to the interventionalist.
"What we found was that actually the top 10% of cases contributed 60% of the cumulative radiation dose, and actually the top 5% of cases contributed 45% of the cumulative dose,” Abiragi explained.
By contrast, lower-dose cases contributed very little overall exposure. Looking at the median dose that included the 50th percentile and less, that only contributed 5% of the total cumulative radiation dose to the interventionalists.
The cases included a mix of diagnostic coronary angiography and angiography with percutaneous coronary intervention (PCI). When the investigators looked more closely at which cases fell into the highest dose category, one factor stood out.
“The thing that predicted high dose more than anything else was if it was a STEMI case,” Madder said. He added that STEMI procedures had a sixfold greater odds of being in that 90th percentile or higher for the radiation dose for the physician.
Madder suggested that the urgency, stress and serious focus on the patient in these cases may lead teams to pay less attention to following radiation precautions.
“We're so focused on quickly taking care of the patient, opening up the artery that we may be forgetting about radiation safety,” he said.
The researchers also found that the top 10% outlier high dose phenomenon extended beyond interventional procedures and was also seen in structural cases, with elevated exposure seen in the operators, interventional echocardiographers, nurses and techs.
Abiragi said a key takeaway is that commonly reported median dose statistics may underestimate risk, because they do not accurately represent the true cumulative dose.
The authors emphasized that the study is hypothesis-generating, but believe it highlights an important opportunity.
“Your cumulative dose is only going to be as good as your high dose outlier cases,” Madder said. He added that even a small number of lapses in following radiation safety protocols could significantly raise annual exposure and should be a focus of future radiation studies and mitigation efforts.
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]