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Occupational health risks common in cath lab workers
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A new survey from the Healthy Cath Lab Study Group highlights increased risk for health problems among cardiac cath lab staff who perform fluoroscopy-guided procedures, including orthopedic illness, skin lesions, cataracts, hypertension, anxiety and depression, compared with staff not exposed to radiation.
Further, occupational health risks appear significantly higher for physicians compared with other personnel and for those with a longer work history.
Maria Grazia Andreassi, MSc, PhD, from the CNR Institute of Clinical Physiology, Pisa, Italy, and colleagues report questionnaire responses and analysis of 466 staff working in interventional cardiology and cardiac electrophysiology with regular exposure to radiation during fluoroscopy-guided cardiac procedures (281 men; mean age 44 years) and 280 staff unexposed to radiation, including physicians, researchers, biomedical industry employees, nurses, and technical and administrative staff (179 men; mean age, 43 years). Those exposed included 218 interventional cardiologists and electrophysiologists (168 men; mean age, 46 years), 191 nurses (76 men; mean age, 42 years) and 57 technicians (37 men; mean age, 40 years); all reported working for a median of 10 years.
Compared with unexposed staff, those who regularly perform fluoroscopy-guided procedures had a significantly higher prevalence of:
- orthopedic illnesses of the back, knee or neck (30.2% vs. 5.4%; P < .001);
- hypertension (12.9% vs. 7.5%; P = .02);
- anxiety and/or depression (12.4% vs. 2.1%; P < .001);
- hypercholesterolemia (12% vs. 4%; P < .001);
- skin lesions (8.6% vs. 2%; P = .002);
- thyroid disease (7.5% vs. 3.6%; P = .03); and
- cataracts (4.7% vs. 0.7%; P = .003).
The prevalence of cancer (2.6% vs. 0.7%; P = .09) and diabetes (1.5% vs. 1.1%; P = .62) was higher but not statistically significant. In addition, the risk for CV events was not different between those exposed or unexposed (0.2% vs. 0.7%; P = .29), despite a higher prevalence of hypercholesterolemia and hypertension in the exposed group.
The prevalence of health problems was highest among physicians and lowest among technicians. When the researchers analyzed a composite endpoint that included disease potentially linked to occupational radiation exposure, the highest prevalence was reported by interventional cardiologists and electrophysiologists (69%), followed by nurses (22%) and technicians (9%; P = .03 for comparison).
Compared with unexposed staff, those with the longest work history with occupational radiation had higher risk for cataracts and cancer. The adjusted OR for cataracts was 6.3 (95% CI, 1.3-30) among staff with 6 to 15 years of exposure and 10.6 (95% CI, 2.1-52) among staff with 16 or more years of exposure, and the adjusted OR for cancer was 8.7 (95% CI, 1.5-52) among staff with 16 or more years of exposure.
Among physicians with the highest exposure, the adjusted OR remained increased for hypertension (1.7; 95% CI, 1-3), hypercholesterolemia (2.9; 95% CI, 1-5), cancer (4.5; 95% CI, 0.9-25) and cataracts (9; 95% CI, 2-41).
The researchers noted several limitations of the study, including the questionnaire format and no direct assessment of radiation dose.
“Our findings are to be considered with caution, and further larger studies are certainly needed at this point,” Andreassi and colleagues wrote. One such study is the ongoing Multi-Specialty Occupational Health Group cohort mortality study that will compare cancer and other disease outcomes including CVD and cataracts among 44,000 physicians who performed fluoroscopy-guided procedures and 12,000 noninterventional radiologists vs. 101,000 unexposed physicians.
“In the meantime, every effort should be made to raise the radiation awareness in the professional communities of interventional cardiologists and cardiac electrophysiologists. … The results of the present study confirm and emphasize this message and will hopefully contribute to spread the culture of safety in the cardiac catheterization laboratory,” Andreassi and colleagues wrote. – by Jennifer Byrne Disclosure: The researchers report no relevant financial disclosures.
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