Healthcare professionals performing X-ray guided cardiovascular procedures may have a higher risk for health problems including orthopedic illness, cataracts, skin lesions and cancers, according to new research in the American Heart Association journal Circulation: Cardiovascular Interventions.

The findings are based on an Italian survey of 466 workers who had an average 10 years’ experience working in cardiac catheterization labs and 280 professionals who worked in other settings.

Researchers identified potential radiation-related health risks to people who perform common cardiovascular procedures using fluoroscopy — a technique that uses X-rays to obtain real-time moving images of the heart. Such procedures include coronary angiography to diagnose heart problems and coronary artery angioplasty to widen narrowed arteries. These procedures are commonly done in a hospital cath lab.

“For experienced, busy interventional cardiologists and electrophysiologists, annual exposure to radiation is around 5 millisievert (mSv, a unit of measure for radiation’s biological effects),” said Maria Grazia Andreassi, M.Sc., Ph.D., lead author of the study and head of the Genetics and Molecular Epidemiology Unit at the National Research Council Institute of Clinical Physiology in Pisa, Italy. That amount adds up to 50 to 200 mSv, or the equivalent of 2,500 to 10,000 chest X-rays, over a 30-year career.

Compared to healthcare professionals not exposed to radiation, cath lab workers (including doctors, nurses and technicians) exposed to radiation for a median of 10 years had:

  • 2.8 times higher odds of having skin lesion
  • 7.1 times higher odds of having orthopedic (back/neck/knee) problems
  • 6.3 times higher odds of having cataracts

Cath lab workers also had elevated rates of high blood pressure and high cholesterol, but relatively low rates of cardiovascular illness. However, previous epidemiological studies have linked chronic radiation exposure with long-term cardiovascular effects. “Unfortunately, cardiologists pay little heed to monthly or cumulative reports of radiation exposure,” Andreassi said. “And recent studies confirm that simple, effective protection measures — such as a lead curtain, protection glasses and thyroid collars — are not used by the majority of exposed cardiologists.”

Intensive training in radiation protection can reduce occupational doses dramatically, Andreassi said.

Among cath lab workers, estimated radiation exposure was highest in interventional cardiologists and electrophysiologists. The odds of having medical problems also increased for workers with more than 16 years of history in cath labs. After adjusting for age, gender and smoking, workers with more than 16 years of history in the cath lab also had three times high odds of having cancer.