Occupational risk of being an interventional cardiologist in the Cath lab

[Medee]

I'm a 3rd year med student interested and considering cardiology as a possible career path. One of my concerns if one were to go the route of invasive or interventional cardiology is the routine exposure to radiation in the cath lab, during diagnostic and interventional procedures.

I've attempted to look for any studies which may have been conducted looking at adverse health outcomes or reports of increased incidence of certain cancers amongst cardiologists who routinely spend time in the cath lab but have been unable to find anything informative or reassuring.

Does anyone in the SDN community have any insite on this issue or know of any studies to read up on that have addressed it? Despite all of the protective lead gear and radiation exposure badges the one is supposed to wear to ensure you do not exceed certain exposure levels, Is the radiation exposure that one gets in the cath lab something to worry about significantly increasing ones risk for an adverse health outcome such as cancer?

Thanks ahead of time for any insiteful responses to this post!

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[josephf1]

Do you really think standing next to a fluroscopic machine all day can be safe?What about scattered radiation to areas not covered with lead?
What about what wearing lead all day does to your back?
What about potential needle sticks with HIV/HCV patients that need procedures done?
Shouldnt these MDs with these skills who make themselves available 24/7 be highly compensated?
How much would you need to be payed to assume these occupational risks on a routine basis?
Would you do it for 250K? 350K? 500K?
You better think about it before you commit 4+4+3+2 years to do this. In the mean time the salaries keep plummeting in this field.

 

[Medee]

Hey Joseph,

As far as occupational hazards, I'm more concerned about effects of radiation exposure than potential exposure to bloodborne disease or potential strain of wearing protective lead gear, although these are valid concerns.

As far as the radiation, I'd rather not make assumptions on its potential for harm, which is why I started this thread hoping someone may have information on research or studies which may have addressed this issue.

 

[dreamfox]

my dad is an interventional cardiologist and i turned out fine, well..except for that whole third arm growing out of my forehead at birth, but that's fixed now.

 

[drdavemd]

You may be more concerned about radiation than strain or bloodborne disease, but of all the cardiologists I know, none have bizarre cancers and plenty don't cath anymore because of bad backs. Lead covers all the vital organs and the skin and bones are quite resistant. How resistant exactly? Not sure, the research is poor. There may be some papers out there specifically about cath attendings, but I am not familiar with any. There are some papers which collect data from nuclear plant workers and estimate the effects with chronic low level exposure, but there does not seem to be a significant uptick until you get above fairly high annual doses. Remember that every hospital was an office for radiation safety and they have everyone wear exposure badges on top of and underneath their lead to calculate just how much you are getting.

Overall, I'd bet your chances of being killed in a car crash on your way home from work are notably higher than getting CA from doing cath.

 

[ethat001]

Great question, and this should be data that is easily accessible -- yet it is not. Occupational safety concerns are real and should be considered when choosing a specialty.

I will tell you that the lifetime risk actually turns out to be very small. First, as an invasive cardiologist (ie. cardiologist that does occasional caths ~200/year, ~2-5/week) -- the risk is not worth mentioning. Radiation exposure is only 5-10 minutes per case and with shielding / minimizing fluoro time shouldn't really be an issue.

Interventional cardiology (ie. who places stents) and electrophysiology (ie. ablations, ICDs) both have higher exposures due to need for longer fluoro times. Peripheral procedures for interventionalists can last 3-4 hours. Electrophysiology ablations can also last 3-5 hours.

Risks are usually limited to back problems and cataracts. Usually because cardiologists forget/refuse to wear leaded glasses. Cancer risks are present but very small.

I wish I had the energy to look up statistics from the annual radiology lectures which I slept through.. Perhaps you can find something online, or someone else can give you numbers to be sure.

 

[ethat001]

Also - to be sure, a quick way to find out is call the radiation safety officer for your hospital - just ask the operator for their number. (They are usually very boring people who sit at a desk all day to crunch radiation numbers, and if you go over your radiation limit they pull you out of the lab). Anyway, I'm sure they'd be happy to discuss this with you and even send you powerpoints/etc.

Sure - I don't know any cardiologists with cancer - but unless I knew thousands of cardiologists over a lifetime of exposure, I wouldn't have the statistical power to make any conclusions. Many attendings become pretty cavalier over time and not uncommonly come into the lab without lead (hiding behind fellows). I know two female attendings (interventionalist & electrophysiologist) who were pregnant and did all her procedures up until at least 7 months -- with double lead. Their babies did not appear to glow.

Of note, lead aprons reduce exposure by 80-90%, but not 100%.

 

[Medee]

Thanks ethat001. Your advice is very helpful!

 

[Aaron Earles]

I have no data to quote you, but I can tell you some of the problems the cardiologists I work around have stated.

You need to wear the lead glasses to reduce the risk of cataract formation, as the radiation can increase that risk. Most of the cardiologist working for several years complain to me that they have developed neuropathy in their hands if they dont wear lead lined sterile gloves. These gloves are more expensive and they dont have the "feel" that normal latex gloves have.

As long as you wear your thyroid and lead shield, you should be ok.