A new expert consensus statement calls for the immediate adoption of safer technologies that are now available to protect health care professionals performing minimally invasive procedures in cath labs from the well-known and preventable hazards of radiation exposure and orthopedic injuries. Led by the Society for Cardiovascular Angiography & Interventions (SCAI), the American Society of Echocardiography, the Heart Rhythm Society, the Society of Interventional Radiology and the Society for Vascular Surgery, and endorsed by the ACC and others, the statement was published July 14 in JACC: Cardiovascular Interventions.

Additionally, the statement calls for hospitals, manufacturers, regulators and professional societies to modernize radiation safety standards and strengthen monitoring and reporting practices to better protect health care teams working in fluoroscopy laboratories.

Given the availability of safer technologies, the authors say broader implementation of enhanced radiation protection devices (ERPDs) is both an ethical responsibility and a necessary evolution of ALARA, the longstanding radiation safety standard that exposures should be kept “as low as reasonably achievable.”

ERPDs reduce radiation exposure through engineering controls rather than relying primarily on personal protective equipment. The consensus statement cites evidence that ERPDs can reduce operator and staff radiation exposure by up to 99%.

Some 60% of interventional cardiologists have reported orthopedic injuries and 17% reported limiting time in the cath lab to reduce radiation exposure, according to a survey conducted in 2023 by SCAI and cited in the statement. Moreover, among the women who responded, 28% reported being discouraged from working in the cath lab because of pregnancy or considering pregnancy, and 71% wanted the option to step away from the cath lab during pregnancy.

“This consensus statement addresses the often-overlooked risks of radiation exposure, including cancer, cataracts, and musculoskeletal injuries. It provides a clear, evidence-based path to better protect the health and longevity of clinicians working in fluoroscopic environments," said Roxana Mehran, MD, FACC, a co-author of the consensus statement and president of the ACC.

The statement calls for health care organizations and policymakers to:

1. Share responsibility among health care institutions, manufacturers, regulators and professional societies for improving occupational safety in fluoroscopy laboratories.
2. Adopt ERPDs that can dramatically reduce occupational radiation exposure for physicians and staff.
3. Modernize federal and state radiation safety regulations to reflect today’s technology and evidence.
4. Measure and report radiation safety performance using real-time dosimetry and standardized quality metrics.
5. Design safer fluoroscopy laboratories by integrating enhanced radiation protection into imaging systems and procedure rooms instead of relying primarily on heavy wearable lead.
6. Expand education, training and research to accelerate implementation and continuous improvement.

“For decades, we accepted occupational radiation exposure and the physical burden of heavy protective equipment as unavoidable realities of working in a fluoroscopy laboratory,” said David G. Rizik, MD, FACC, MSCAI, chair of the writing group. “That is no longer acceptable. Technologies available today can greatly reduce radiation exposure while also addressing the orthopedic injuries associated with traditional lead protection. The question is no longer whether these solutions exist. It is whether we are willing to make protecting healthcare workers the priority it deserves. This consensus makes clear that the time for implementation is now.”