Cath lab workers have higher risks of cancer, cataracts, and other health problems

Doctors and staff who work in cardiac catheterization laboratories have 3 times the risk of cancer and 7 times the risk of orthopedic problems—as well as higher rates of skin lesions, cataracts, and other illnesses—when compared with health care workers not exposed to radiation, according to a study published online April 12, 2016 in the journal Circulation: Cardiovascular Interventions.

The study found that cath lab personnel are also more likely to have hypertension, hypercholesterolemia, anxiety, and depression.

The more years worked in the cath lab, the greater the radiation exposure and the higher the risks, the researchers found.

“For experienced, busy interventional cardiologists and electrophysiologists, annual exposure to radiation is around 5 mSv,” said lead author of the study Maria Grazia Andreassi, MSc, PhD, head of the Genetics and Molecular Epidemiology Unit at the National Research Council Institute of Clinical Physiology, in Pisa, Italy.

Over a 30-year career, that adds up to a significant exposure of 50 mSv to 200 mSv—or the equivalent of 2,500 to 10,000 chest X-rays. The findings raise “the need to spread the culture of safety in the cath laboratory,” the authors concluded.

For this study, investigators in Italy surveyed 466 people (including doctors, nurses, and technicians) who had an average of 10 years’ experience working in cardiac cath labs. They also surveyed 280 people who worked in other health care settings. After adjusting for age, gender, and smoking status, the results showed that cath lab workers had:

• 2.8 times higher risk of skin lesions
• 3.0 times higher risk of cancer
• 3.1 times higher risk of hypercholesterolemia
• 6.3 times higher risk of cataracts
• 7.1 times higher risk of orthopedic (back/neck/knee) problems

The findings also showed that people who worked in the cath lab for more than 16 years had even higher odds of having medical problems.

They also found that “interventional cardiologists and electrophysiologists have a 2 to 3 times higher annual exposure than that of radiologists, as they are closer to the radiological source and experience radiation exposure with the patient, whereas diagnostic radiologists are generally shielded from radiation exposure,” Dr. Andreassi said.

The researchers observed that cancers tended to occur more frequently on the worker’s left side, where exposure to the radiation beam is greater.

Notably, exposed workers reported 6 times the rate of anxiety/depression, which might be due to the high stress and psychological strain of the work environment but also possibly a direct effect of radiation on the worker’s unprotected head, the researchers noted.

With the findings from this study, “There is now more than enough information for us to conclude that the interventional catheterization laboratory is not a healthy workplace,” wrote Lloyd W. Klein, MD, and Mugurel Bazavan, MD, of Advocate Illinois Masonic Medical Center and Rush Medical College, in Chicago, IL, in an accompanying editorial.

“Interventional cardiology has witnessed amazing technical and imaging advancements accompanied by extraordinary patient outcomes during the past few decades,” they wrote. “However, during the same time period, there has been almost no substantial modification in cath lab design and little change in the incidence of injury to personnel, despite widespread recognition of the occupational hazards of the catheterization laboratory environment.”

Drs. Klein and Bazavan concluded, “We call on industry and hospital administration to provide responsible stewardship, and for physician societies and interventional leaders to advocate visibly and set new priorities, so that those of us who choose to help patients live a longer and healthier life can ourselves enjoy a long and healthy career.”