Radiation Risk: Revisited

[blastoise]

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Hey guys, was just looking into this and I didn't see any recent post from this year regarding the radiation risks inherent to the field. I ask for an updated view because the way this field is practiced now compared to 5-10 years ago, as well as the studies available to us, change fairly quickly.

I'm currently a medical student looking forward to diagnostic rads and also a little excited about the potential to do IR. However, studies like the one below have show that there is a high % of interventionalists (cardiology/radiology) that experience brain tumors specifically in the left side (which is most exposed to radiation). I know that this field isn't void of occupational risk, but it does worry me to the point where i'm irrationally feeling a fear of entering this subspecialty.

http://www.ncbi.nlm.nih.gov/pubmed/23419190

What do you guys think about this (i.e. the cancer risk/cataracts) inherent to the field of IR or IC and if that should matter at all. Do any of you who practice IR wear any protective head gear to protect the brain. Not many of the interventionalists i've seen use them and I fear that i'll look like an idiot advocating for that when none of the attendings think twice about it.

 

[shark2000]

Nothing is safe.

The past generation of interventionists didn't get cancer right and left. However, you have to consider that there has not been any case-controlled studies and finding a control group with similar risk factors is almost impossible. Also the length of procedures is longer today. There is a huge difference between case volume among interventionist that you can not put all of them in one category.

It is like saying whether the risk of HIV is higher among surgeons or not. When comparing to general population, it is even lower. However, generally speaking high risk behaviors are less common among physicians compared to general population.

Cancer is a very complex entity and most of the time its risk factors are unknown to us. This complicates the issue even more.

Bottom line, nobody knows. The risk is not high, however there may be a little increased risk of getting cancer working in a high volume fluoro/angio suit (or may not).

 

[chronicidal]

why is the left side more exposed than the right?

 

[DrBowtie]

why is the left side more exposed than the right?

Most access the pts right groin due to the primary operator being right handed. The II would then be closer to the operators left.

 

[meister]

I know of an IR who passed away who developed a left sided GBM. Hard to ignore.

 

[shark2000]

I know of an IR who passed away who developed a left sided GBM. Hard to ignore.

This is my knowledge about this topic.

The GBM is not significantly more common among interventionists (IR and IC and vascular surgery) compared to general population. However, the population of interventionists are small compared to the incidence of GMB. The GBM has an incidence of probably 1/10000-1/100000 in the general population. On the other hand, there are only 5000 IRs practicing in the US. Probably similar number of ICs practicing. Also the volume of their practice is very different. For example, believe it or not, in a small community hospital in Seattle an IC or IR may do only 2 cases of high end vascular per week. My wife's friend who is an IC did only about 70 PCIs last year.

So far there are two factors that make the power of study very weak: 1. Very low number of interventionists compared to the incidence of GBM. 2. Huge variability in the number of cases done by interventionists. The third confounding factor is the relatively short history of especially long interventions in the history of medicine. Something like complex vascular interventions like CTO (chronic total occlusion) or long cases of TACE have not been out there for a long time. Allowing for the low power of the study, there is no significant difference in incidence of GBM in interventionists compared to general population.

However, another study showed that though GBM has similar distribution in the right and left hemispheres among general population, its distribution is way different among interventionist. When it happens among interventionists, 90% of the time it is in the left hemisphere which is concerning for being caused by radiation. Again, the problem is that the number of cases are low so the study has low power.

Bottom line is that the risk of cancer is not significantly higher, but there may be a higher risk.

 

[chronicidal]

I heard some cards at my institution are using a vascular robot (after getting access, the interventionist sits in the control room remotely controlling the catheter). Any uptake in IR?

http://www.corindus.com/

 

[blastoise]

why not just wear a lead cap? would most interventionalists not think of doing that just in case? i know it can be annoying to have on but i'm sure there are types out there that are not particularly heavy/uncomfortable

 

[deleted525628]

I'm wondering what kind of tactile feedback this device provides. It's not uncommon that you can perforate a coronary artery when you are trying to cross a difficult lesion.

 

[blebb]

I'm wondering what kind of tactile feedback this device provides. It's not uncommon that you can perforate a coronary artery when you are trying to cross a difficult lesion.

No IRs doin interventional cards brah

 

[meister]

There might be a handful left...

 

[preDoGuy24]

No IRs doin interventional cards brah

Not in the US. But the idea of lack of tactile feedback still holds up with the robot, have heard several IR guys state they don't think it will catch on specifically because of that and the importance of feel in doing their procedures.

 

[badasshairday]

why not just wear a lead cap? would most interventionalists not think of doing that just in case? i know it can be annoying to have on but i'm sure there are types out there that are not particularly heavy/uncomfortable

I wear a lead hat. Looks way better than a bouffant too,

 

[Shifty B]

A lead cap sounds hot and disgusting. The lead used is pretty hot and disgusting anyway. Plus I'm not sure the added weight is great for your neck. Not many radiologists get GBMs, but a lot of them get neck/back problems which are probably exacerbated by wearing lead.

There is plenty more that you can do to reduce your radiation dose without wearing more lead:
- proper table height
- appropriate collimation
- appropriate frame rates
- good positioning of shields both adjacent to the patient and below the table
- limiting unnecessary fluoro time/runs
- making sure your equipment

Hell, just step back 1 foot from the table when doing hand runs.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767881/bin/ht02525a.f2.jpg

 

[je355804]

A lead cap sounds hot and disgusting. The lead used is pretty hot and disgusting anyway. Plus I'm not sure the added weight is great for your neck. Not many radiologists get GBMs, but a lot of them get neck/back problems which are probably exacerbated by wearing lead.

There is plenty more that you can do to reduce your radiation dose without wearing more lead:
- proper table height
- appropriate collimation
- appropriate frame rates
- good positioning of shields both adjacent to the patient and below the table
- limiting unnecessary fluoro time/runs
- making sure your equipment

Hell, just step back 1 foot from the table when doing hand runs.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767881/bin/ht02525a.f2.jpg

Do you even deadlift bro?