Radiation exposure in interventional cardiology: a narrative review of health effects and novel approaches to ensure radiation safety

Introduction

Background

Interventional cardiology (IC) is a rapidly growing medical specialty that utilizes invasive techniques to diagnose and treat cardiovascular disease (CVD). The procedures involved, such as coronary angiography, percutaneous coronary intervention, right heart catheterization, and radiofrequency catheter ablation, play a crucial role in detecting and treating a wide range of cardiac disorders. However, these IC procedures come with the potential risk of exposing healthcare professionals to high levels of ionizing radiation (IR) (1-3). The use of IR enables internal visualization of the body and guidance of procedures, but it also poses significant health risks to workers in this field (4-7).

Professionals working in IC, including interventional cardiologists, radiology technologists, and nurses, face prolonged and recurrent exposure to IR due to the complexity and adjustments required in IC departments. While patients are exposed to IR for a short duration during procedures, healthcare workers endure continuous and repeated exposure, increasing their vulnerability to various health issues.

The surge in IC procedures has undeniably transformed cardiovascular care, yet it has concurrently elevated concerns regarding IR exposure for medical professionals involved. Acknowledging IR as a predominant artificial source of exposure in IC, this heightened use has become particularly evident over the past two decades (8). The escalating number of IC examinations, tripling in European countries between 1992 and 2001, has amplified the radiation effective dose, accounting for 12.0% of all IC procedures and more than 50.0% of the overall radiation effective dose (9). The localized nature of scattered radiation, particularly affecting the lower part of the cardiologist under specific X-ray machine configurations, highlights the occupational risk faced by Cath-lab personnel (10). Complex IC procedures further compound this risk, with a subset of patients receiving significant doses, raising concerns about potential long-term health implications for professionals (11).

The annual effective radiation doses for Cath-lab staff, including interventional cardiologists, have been estimated to reach up to 50 mSv in high-load circumstances, posing a potential risk of cancer and CVD over time (12,13). Cumulatively, even with individual yearly doses below 50 mSv, the constant exposure from daily IC procedures prompts consideration of long-term health risks for these professionals (14). The lens of the eye, being particularly radiosensitive, raises concerns about cataract development among Cath-lab personnel due to IR exposure. Additionally, reported cases of brain cancer among interventional cardiologists emphasize the importance of recognizing potential health risks for professionals with prolonged exposure (15).

The cumulative effect on the health of Cath-lab personnel, as evidenced by potential cataract development after 30 years of employment and a lifetime additional radiogenic risk ranging from 50 to 200 mSv, underscores the necessity for stringent safety measures (16). As professionals in high-load Cath-lab departments may execute thousands of procedures annually, the imperative to mitigate radiation exposure and prioritize the well-being of interventional cardiologists and staff becomes paramount for the sustained advancement of IC procedures.

Rationale and knowledge gap

Numerous studies have been conducted to assess the impact of IR exposure on IC professionals. These studies have revealed a range of risks, including an increased risk of cancer, somatic DNA damage, thyroid disorders, cataracts, and skin lesions (17-21). Despite efforts to optimize procedures and minimize radiation exposure, the results of these studies often yield contradictory findings and are challenging to interpret due to the multifaceted factors influencing radiation exposure and the methodological limitations of some studies.

Objective

Given the importance of ensuring the well-being of IC workers and safeguarding their health, this study aims to consolidate the findings of existing research on the effects of IR exposure in this field. By synthesizing the results of previous studies, we seek to develop comprehensive recommendations and innovative approaches to enhance radiation protection for healthcare professionals who are exposed to IR during IC procedures. With a focus on interventional cardiologists, radiology technologists, and nurses, we aim to provide valuable insights to address the risks associated with IR exposure in IC and improve the overall safety and well-being of these dedicated healthcare workers. We present this article in accordance with the Narrative Review reporting checklist (available at https://tro.amegroups.com/article/view/10.21037/tro-23-25/rc).

Methods

Selection criteria for studies

The selection of studies for the narrative review part followed specific criteria to ensure the inclusion of relevant and reliable research. The inclusion criteria consisted of studies that were published in indexed peer-reviewed scientific journals. Moreover, the research needed to include information on the health impacts of IR exposure specifically among workers in IC. The target population included healthcare professionals, such as interventional cardiologists, radiology technicians, and nurses, who were exposed to IR during IC procedures. The studies had to be published in either English or French to maintain consistency in language. By employing these criteria, a comprehensive and focused set of studies was identified for analysis.

Databases and search terms

A systematic search was conducted in prominent bibliographic databases, including PubMed, Scopus, and Web of Science. The search strategy involved utilizing relevant keywords to identify studies related to IR, IC, healthcare workers, occupational exposure, health effects, etc. See Table 1. These search terms were carefully selected to encompass the key aspects of the research topic. By utilizing multiple databases and comprehensive search terms, a broad range of studies were identified, enhancing the inclusiveness and robustness of the narrative review.

Study selection process

The study selection process involved a systematic approach to ensure the identification of relevant and high-quality studies. Initially, the literature search was conducted between January and June 2023, resulting in the identification of a total of 128 potentially relevant articles. The titles and abstracts of these studies were reviewed to evaluate their suitability for addressing the research objective. Subsequently, full-text articles were obtained for the studies that met the inclusion criteria. A thorough evaluation of the full-text articles was conducted, and studies that did not meet the criteria or lacked relevant data were excluded. Through this rigorous selection process, a final set of 35 studies was included in this narrative review.

Data analysis and quality assessment

Data extracted from the selected studies were subjected to a qualitative analysis. The results were organized and presented in tables and narrative summaries to facilitate a comprehensive understanding of the findings. The extracted data were categorized based on the specific health effects studied. Quality assessment criteria for the included studies were applied. The assessment focused on evaluating the study design, methodology, sample size, and statistical validity. High-quality studies were given priority during the data analysis and synthesis process to ensure the reliability and validity of the results. By employing rigorous quality assessment measures, the overall robustness of the narrative review was enhanced.

Results

The studies included in this narrative review examined the health effects of exposure to IR among IC workers. The results were grouped according to the studied health effects, including CVDs, cancers, genetic disorders (GDs), cataracts, and others.

CVDs

A study by Baselet et al. (22) provides compelling evidence linking low IR doses to an elevated likelihood of developing CVD. Recent epidemiological findings challenge the traditional threshold dose concept, showing an excess risk of CVD even below 100 mGy. While the relationship between dose and risk is still unclear for exposures below 0.5 Gy, the study emphasizes the importance of understanding the underlying biological and molecular mechanisms involved in radiation-induced CVD. Endothelium models are considered critical targets of radiation exposure, impacting vascular homeostasis. Refining the radiation protection system based on this research can lead to more accurate assessment of cardiovascular risks in the low-dose region and potentially pave the way for risk-reducing strategies.

Another systematic review and meta-analysis conducted by Little et al. (23) examined the radiation-induced risks of CVD across different cohorts exposed to radiation. The comprehensive analysis encompassed 93 pertinent studies, revealing an elevated relative risk (RR) per unit dose (Gy) for all CVD subcategories. The observed heterogeneity in the findings suggests potential variations in unmeasured confounders or effect modifiers. However, focusing on studies of higher quality or those involving moderate doses and low dose rates helped mitigate this heterogeneity. This study furnishes evidence supporting a causal link between radiation exposure and CVD, particularly at higher doses, while noting nuanced disparities between acute and chronic exposures. Further investigation is warranted to elucidate the influence of lifestyle factors and medical comorbidities on radiation-induced CVD.

A study performed by Wakeford (24) revealed that exposure to low levels of IR may be associated with an increased risk of CVD. The research focused on groups of workers exposed to radiation, particularly those at the Mayak nuclear installation in Russia. Epidemiological studies showed positive associations between CVD incidence and external radiation dose. Another investigation, the International Nuclear Workers Study (INWORKS), found increased CVD mortality with cumulative occupational radiation dose. However, uncertainties in interpreting results and the absence of an accepted radiobiological mechanism complicate the understanding of this radiation-related CVD risk. Further research is needed to establish a conclusive link between low-level radiation exposure and CVD.

Cancer effect

Exposure to IR has been associated with an increased risk of various cancers in IC professionals.

A study conducted by Roguin et al. (25) revealed that interventional cardiologists operating in cardiac catheterization laboratories are subjected to low levels of IR, potentially posing health risks. The researchers documented four cases of interventional cardiologists diagnosed with brain malignancies in the left hemisphere. Additionally, they identified five additional cases, resulting in a total of six interventional cardiologists and three interventional radiologists with brain tumors, all of whom were exposed to prolonged radiation in their work environments. While a biological association with occupational radiation exposure is conceivable, accurately assessing the risk is challenging due to the limited sample size and low incidence of tumors. This study underscores the imperative for further investigation to comprehend occupational hazards and emphasizes the significance of radiation safety awareness and training for interventional cardiologists, given their heightened exposure to radiation compared to other healthcare professionals.

A comprehensive study on the occupational effects of IC (26), involving 615 participants, of which 72.8% were interventional cardiologists, revealed potential health issues associated with radiation exposure. Among the participants, 19.5% reported orthopedic problems, such as back, neck, and hip pain, while 5.5% experienced varicose veins. Additionally, 2.4% of participants faced blood count problems, and 2.0% had cataracts. Interestingly, the study found a significant association between orthopedic issues and years of exposure (P=0.001). However, the incidence of diagnosed cancer was relatively low, with only 2.2% of participants affected. Notably, there was a trend indicating a higher cancer prevalence in females compared to males (4.4% vs. 1.8%, P=0.07).

Furthermore, an analysis of 16 epidemiological studies encompassing cohorts of cardiologists conducted by Chartier et al. (27) demonstrated elevated cancer risks linked to radiation exposure, particularly notable for exposures preceding the 1950s and prolonged durations of exposure. The review concentrated on assessing cancer risks associated with radiation exposure within this professional group and underscores the necessity for vigilant monitoring of occupations with high levels of exposure, particularly interventional physicians and nuclear medicine practitioners.

These findings emphasize the need for effective radiation protection measures and regular screening programs to mitigate the risk of cancer development in this occupational setting.

GDs

To explore the potential correlation between radiation exposure and dementia, we referenced a 2023 meta-analysis. This study, which examined populations exposed to chronic low-dose radiation due to occupational, environmental, or medical factors, drew upon data from a range of sources, including survivors of atomic bombings, patients undergoing radiation therapy, occupationally exposed workers, individuals with environmental radiation exposure, and patients undergoing diagnostic radiation imaging. Utilizing Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, our review identified 18 pertinent studies, which were then subjected to meta-analysis. Our analysis revealed a significant association between IR exposure and a higher likelihood of developing dementia, with a summary RR of 1.11 [95% confidence interval (CI): 1.04, 1.18; P=0.001] across all dementia subtypes and 1.12 (95% CI: 1.07, 1.17; P<0.001) for Parkinson’s disease incidence and mortality when comparing individuals receiving 100 mSv of radiation to those with no exposure. These findings highlight the need for further investigation to deepen our understanding of the potential causal link between radiation exposure and neurodegenerative diseases (28).

A study by Sakly et al. (29) explored chromosomal aberrations (CA) and micronuclei (MN) in peripheral blood lymphocytes among hospital personnel exposed to IR. The study aimed to assess the frequencies of CA and MN in workers from radiology and cardiology departments, as these biomarkers serve as indicators of genomic instability and potential predictors of cancer risk. The investigation involved 30 individuals from the radiology department, 30 from the cardiology department, and 27 healthy controls, matched with the exposed workers in terms of age and sex. Chromosomal damage assessment was conducted through CA and MN assays in peripheral lymphocytes. The findings revealed significantly higher frequencies of both CA and MN in the exposed groups (radiology and cardiology workers) compared to the control group, indicating an elevated risk of chromosomal damage among these workers due to their exposure to IR.

Exposure to IR has been associated with somatic DNA damage based on a study investigating the effects of chronic low-dose X-ray radiation exposure on interventional cardiologists working in high-volume cardiac catheterization laboratories (30). The study used peripheral lymphocytes and the MN assay as reliable biological dosimeters for radiation exposure. Interestingly, the extent of DNA damage did not strongly correlate with the duration of professional exposure, suggesting that environmental factors might play a more dominant role in determining the harm experienced by individual physicians.

While this study entails a follow-up spanning decades, it is crucial to highlight the significance of molecular or genetic epidemiology studies. This approach allows the documentation of detrimental effects on a relatively small sample size within a cross-sectional study, eliminating the necessity for studying thousands of exposed professionals over extended periods.

The primary objective of a recent study was to evaluate genomic instability among radiologists by examining CA, MN, and 53BP1 DNA repair foci in peripheral blood lymphocytes. Adhering to the guidelines established by the International Atomic Energy Agency (IAEA) for biodosimetry using dicentrics, the study determined the average protracted whole-body dose in radiologists. In addition to conventional analyses, the study investigated the presence of preleukemic fusion genes (PFGs), specifically MLL-AF4, MLL-AF9, AML1-ETO, and BCR-ABL p190, which are known to be primary events leading to leukemia, utilizing both reverse transcription quantitative polymerase chain reaction (RT-qPCR) and fluorescence in situ hybridization (FISH) techniques.

The findings of this study indicated no significant differences in 53BP1 foci and the incidence of PFG when comparing interventional radiologists to controls. However, an increased frequency of MN and various types of CA, including dicentrics, was observed in the cells of interventional radiologists. The average protracted whole-body estimated dose for this cohort was determined to be 452.63 mGy. Additionally, the study identified a significantly higher amplification of the MLL gene segment and increased RNA expression in cells from interventional radiologists compared to the control group (31).

Cataract

A study focusing on the risk of cataracts among interventional cardiologists (32) revealed that these healthcare practitioners are highly prone to developing radiation-induced cataracts due to their exposure during cardiac catheterization procedures. The systematic review and meta-analysis, comprising eight studies with a total of 2,559 subjects, unveiled a significantly elevated incidence of posterior lens opacity among interventional cardiologists compared to the control group (RR =3.21; 95% CI: 2.14, 4.83; P<0.001). However, no notable differences were discerned between the two groups concerning cortical lens opacity (RR =0.69; 95% CI: 0.46, 1.06; P=0.09) and nuclear opacity (RR =0.85; 95% CI: 0.71, 1.02; P=0.08). The study underscores the importance of further research and intervention strategies to safeguard the well-being of these healthcare professionals. Another study by Ciraj-Bjelac et al. (33) demonstrated a dose-dependent escalation in the risk of posterior lens opacities among interventional cardiologists and nurses when radiation protection tools are not utilized. The prevalence of radiation-associated posterior lens opacities was found to be 52% (29/56; 95% CI: 35–73%) for interventional cardiologists.

Others

Other studies have also shown that workers exposed to IR during interventional procedures are at risk of health effects due to IR exposure. A study focused on the olfactory non-cancer effects of exposure to IR in staff working in the cardiac catheterization laboratory. It reported potential neurocognitive effects, including a possible risk of schizophrenia, mental retardation, and cognitive disorders, though the association with medical radiation exposure requires further investigation. This study highlighted that the brain, being a radio-resistant organ, may still experience neural damage and decreased olfactory function due to radiation exposure, indicating the need for vigilance in protecting workers in this field (34).

Furthermore, another study investigated brain and neck tumors among physicians performing interventional procedures, including interventional cardiologists. The findings showed a disproportionate report of left-sided brain tumors, suggesting a potential causal relation to occupational radiation exposure. The study emphasized the importance of monitoring and minimizing radiation exposure during procedures to protect the health of physicians (15).

Additionally, a prospective observational study assessed the occupational radiation exposure of neurointerventionalists during endovascular stroke treatment (EST). The findings unveiled a generally low yet variable radiation exposure during EST, contingent upon factors such as fluoroscopy time, dose area product, and the number of thrombectomy attempts. Although both the left temple and left arm were subjected to radiation, no significant disparity in exposure was observed between these locations. This study emphasized the imperative for continued endeavors aimed at minimizing radiation exposure and safeguarding the health of neurointerventionalists (35).

Taken together, these four studies underscore the potential health risks associated with IR exposure in the field of cardiology. Cardiology workers, especially those performing interventional procedures, are chronically exposed to radiation, which can lead to chromosomal damage, neurocognitive effects, and an increased risk of tumors. The findings emphasize the importance of implementing stringent radiation protection measures and using the latest technologies to reduce radiation exposure in cardiac catheterization laboratories. Regular monitoring and evaluation of occupational radiation exposure should be conducted to safeguard the health and well-being of cardiology workers. By adhering to best practices and guidelines, healthcare facilities can ensure the safety of their personnel and provide optimal patient care. Further research and continuous education are essential to enhance our understanding of the health effects of IR and develop more effective strategies to mitigate risks for cardiology workers and other healthcare professionals exposed to radiation in their daily work.

The deterministic effects of radiation, now termed tissue reactions, become evident following an acute or cumulative threshold dose of radiation [peak skin dose (PSD), >~2 Gy] (36). While relatively rare, these effects predominantly affect patients directly exposed to the X-ray beam in higher-dose procedures. Tissue reactions encompass a range of manifestations including skin erythema, epilation, skin necrosis, and infertility. Historically, interventionalists have faced risks of tissue reactions such as radiodermatitis, hand necrosis, and radiation arthritis due to direct exposure to the primary beam or scatter fields in close proximity to the patient.

Adherence to best practices, such as keeping extremities away from the X-ray beam, can assist operators in avoiding tissue reactions. However, it is crucial to note that a 2014 case report documented hand necrosis in a fluoroscopy operator, highlighting the ongoing necessity for education on radiation protection (14).

Discussion

Finding from the narrative review

The findings from the narrative review on the health effects of exposure to IR among IC workers have brought to light several important considerations for both the medical community and policymakers. The evidence presented in these studies underscores the need for increased awareness and implementation of radiation protection measures to safeguard the long-term health of IC workers.

One crucial aspect that emerges from these findings is the potential need to reevaluate current radiation dose threshold concepts. Studies have shown an increased risk of CVD even at low doses of IR, challenging the traditional belief that only high doses pose health risks. As a result, it becomes essential to adopt a more cautious approach in radiation safety guidelines, particularly for IC workers who are exposed IR frequently.

The heterogeneity of results in some studies also highlights the complexity of the relationship between radiation exposure and health outcomes. Unmeasured confounders and effect modifiers may influence the risk of developing CVDs, cancers, GD, and other health conditions. Therefore, future research should focus on identifying these factors to provide a more comprehensive understanding of the health risks associated with IR exposure in the field of cardiology.

Furthermore, the findings related to cataract formation and genetic damage underscore the importance of implementing strict radiation protection practices in cardiac catheterization laboratories. Effective use of radiation protection tools and ongoing training can significantly reduce the risk of occupational health issues among IC workers. Additionally, regular screening programs should be established to monitor their health and detect potential health problems early on.

It is worth noting that some studies have indicated a higher prevalence of radiation-related health effects in females compared to males. This observation calls for further investigation into potential gender-specific differences in radiation sensitivity and health outcomes among IC workers. Understanding these disparities could lead to targeted interventions and tailored safety measures to protect the health of both male and female workers adequately.

Moreover, the potential neurocognitive effects associated with IR exposure in IC workers raise concerns about the impact on cognitive function and overall well-being. These findings suggest a need for comprehensive health monitoring beyond the traditional focus on CVD and cancer. Continued investigation into the lasting cognitive impacts of radiation exposure is critical for implementing appropriate support and early intervention strategies for affected healthcare professionals.

In conclusion, the collective evidence from the narrative review emphasizes the need for continuous efforts to improve radiation protection measures and optimize the safety of IC workers. Implementing best practices and adhering to guidelines should be a priority for healthcare facilities to ensure the well-being of their personnel and provide high-quality patient care. Additionally, collaboration between researchers, healthcare professionals, and policymakers is essential to further our understanding of the health effects of IR exposure and to develop more effective strategies to mitigate risks for all healthcare professionals exposed to radiation in their daily work. By addressing these challenges proactively, we can create a safer and healthier environment for IC workers and enhance the overall quality of care in this critical medical specialty.

Novel approaches and recommendations to ensure radiation safety in IC

Making radiation protocols more efficient and implementing a thorough radiation safety program should be prioritized during interventional procedures. The primary goal is to reduce radiation exposure whenever feasible, thereby lowering the associated health risks linked to radiation dosage.

The International Commission on Radiological Protection (ICRP) recommends specific dose limits for occupational exposure. For effective dose, the limit is set at 20 mSv per year averaged over 5 consecutive years, with a maximum of 50 mSv in a single year. During pregnancy, the dose to the embryo/fetus should not exceed 1 mSv for the remainder of the pregnancy. Additionally, for the lens of the eye, the equivalent dose limit is 20 mSv per year. The recommended equivalent dose limit for skin is 500 mSv per year, while for extremities (hands and feet), it is also 500 mSv per year. See Figure 1 (37).

Figure 1 Occupational exposure dose limits recommended by ICRP (37). ICRP, International Commission on Radiological Protection.

Optimization strategies for reducing IR exposure in IC are numerous. These strategies encompass several key aspects.

Radiation dose monitoring and feedback systems

Implementing radiation dose monitoring systems (DMS) can provide real-time feedback to healthcare professionals regarding their radiation exposure during procedures. The integration of real-time radiation monitoring devices that provide auditory feedback can significantly decrease radiation exposure during cardiac catheterization procedures.

Equipment optimization

Optimizing imaging equipment plays a vital role in reducing radiation doses. Upgrading to newer-generation imaging systems with improved image quality and lower radiation doses can significantly minimize the radiation exposure to both patients and healthcare professionals. Additionally, utilizing advanced imaging modalities such as low-dose imaging protocols, iterative reconstruction techniques, and dose modulation algorithms can further optimize radiation utilization without compromising diagnostic quality.

Procedural optimization

Adopting procedural optimization techniques can contribute to reducing radiation exposure. This includes careful consideration of the choice of imaging angles, collimation, and positioning of the X-ray beam. By optimizing these factors, healthcare professionals can achieve adequate visualization while minimizing radiation scatter and unnecessary exposure.

The ALARA principle, which stands for “as low as reasonably achievable”, should be the guiding principle for radiation safety. It highlights the importance of reducing radiation exposure, even at low levels, when there is no direct benefit. Effective approaches to minimize exposure for both patients and operators during interventions include:

• Restricting radiation use to essential imaging that aids in clinical care and limiting fluoroscopy time to periods when the operator is actively monitoring the display.
• Optimizing table positioning by placing the image receptor as low as possible on the patient’s chest, with the patient positioned close to the receptor and farther from the X-ray source.
• Reducing the use of steep angles for the X-ray beam helps to minimize scattered radiation during fluoroscopic imaging. Positioning the C-arm at angles between 0° and 20° can substantially lower exposure to scattered radiation.
• Shortening cine acquisitions and minimizing the use of magnification modes, utilizing software magnification algorithms when possible.
• Maximizing collimation to limit the radiation field.
• Modifying the fluoroscopy frame rate to lower settings, such as 7.5 frames per second, can lead to a significant decrease in radiation dose (38).
• Increasing the distance between the operator and the radiation source, such as the X-ray machine, can substantially decrease occupational radiation dose.
• Applying these strategies enables a reduction in radiation doses while maintaining the effectiveness of catheterization procedures.

Equipment-mounted shielding and personal protective equipment (PPE)

The equipment features a primary shield that includes suspended shields from the ceiling and table-side curtains. For optimal effectiveness, proper positioning and proactive management of these radiation shields are crucial. The ceiling-mounted shields, crafted from adjustable leaded clear plastic, can significantly reduce radiation exposure to the operator’s head and neck (39). The lower region of the operator, especially the pelvic area, receives the highest exposure during procedures. Lead drapes suspended from the table between the X-ray tube and the operator significantly reduce radiation dose to the pelvic and thorax levels. Combining pelvic drapes with under-table shields further reduces operator radiation exposure in the thorax area (40). Additional protection is provided by the Transradial Radiation Protection Board (TRPB), which reduces radiation exposure during radial approach procedures (41). A mobile leaded shield placed between the patient and the operator, in conjunction with standard protective measures, effectively reduces the operator’s exposure to IR during interventional procedures.

Strict adherence to wearing appropriate PPE during procedures can significantly reduce radiation exposure to vital organs and sensitive tissues.

Education and training

Comprehensive education and training programs on radiation safety are paramount in optimizing practices in IC. Healthcare professionals should receive training on radiation protection principles, proper use of shielding devices, optimization techniques, and radiation safety protocols. Ongoing educational initiatives and regular updates on the latest advancements in radiation safety practices should be provided to ensure a well-informed workforce.

Collaboration and multidisciplinary approach

Promoting collaboration among healthcare professionals, including interventional cardiologists, radiologic technologists, medical physicists, and radiation safety officers, fosters a multidisciplinary approach to radiation safety. Collaborative efforts can lead to the development of institution-specific protocols, regular quality assurance programs, and sharing of best practices, all aimed at optimizing radiation safety and minimizing unnecessary exposure.

Innovations

In recent years, innovative methods in individual or semi-individual radioprotection have emerged to help reduce scatter radiation. One such approach is the Zero-Gravity suspended radiation protection system, which offers enhanced protection for operators while minimizing fatigue and injuries associated with wearing heavy protective gear (42).

The CathPax mobile radiation protection cabins are effective in reducing radiation exposure and are tailored to specific interventional needs (43). Disposable radioprotective drapes, such as the RadPad, significantly attenuate scatter radiation and reduce operator exposure (44).

Robotic percutaneous systems, such as robotic-assisted percutaneous coronary intervention (R-PCI), offer advantages in reducing radiation exposure and improving precision in measurements and device deployment. However, further clinical evidence and technical improvements are needed for widespread adoption. The efficacy of various other radiation safety innovations, including radiation-blocking hats, gloves, and creams, is still unclear. Biological dosimetry is a technique used to estimate radiation exposure by measuring the biological effects of radiation on an individual’s cells. It is particularly useful for estimating the dose received by medical professionals during certain procedures, such as interventional radiology. These procedures can expose healthcare workers to significant amounts of IR, which may increase their risk of developing cancer or other radiation-related illnesses over time (45).

For pregnant physicians and catheterization personnel, specific protective garments and precautions are recommended to minimize fetal radiation exposure.

In summary, with appropriate safety protocols in place, female interventionists can successfully balance their careers with pregnancy.

Conclusions

The accumulating evidence on the health effects of IR exposure among IC workers underscores the importance of implementing stringent radiation safety measures in this occupational setting. The findings from this narrative review highlight the increased risks of CVDs, cancers, and GD associated with IR exposure. These health consequences have significant implications for the well-being and occupational longevity of IC professionals.

To address these concerns, several recommendations can be made. Firstly, healthcare institutions and regulatory bodies should prioritize the development and implementation of comprehensive radiation protection protocols tailored specifically for IC practices. These protocols should encompass optimizing imaging techniques, utilizing shielding devices and PPE, and implementing DMS.

In conjunction with protective measures, continuous training and awareness programs are crucial. Healthcare professionals involved in IC should receive comprehensive education on radiation safety, emphasizing the potential health risks and the proper use of protective equipment. Regular updates and reinforcement of training programs should be provided to ensure that healthcare workers are equipped with the latest knowledge and best practices in radiation safety.

Moreover, fostering a culture of open communication and reporting of radiation safety concerns is essential. Healthcare institutions should establish mechanisms to encourage workers to voice their concerns, provide feedback on radiation safety practices, and actively participate in the improvement of workplace safety.

Regarding future research, there is a necessity for prospective studies and experimental investigations to better understand the mechanisms underlying radiation-related health effects in IC professionals. Utilizing standardized methodologies and larger sample sizes will improve the robustness and applicability of the results. Additionally, long-term follow-up studies are necessary to assess the cumulative health effects of IR exposure and to evaluate the effectiveness of protective measures in mitigating these risks.

In conclusion, protecting the health and well-being of IC workers from the hazards of IR exposure is of utmost importance. By implementing rigorous radiation safety measures, providing comprehensive training, and fostering a culture of awareness, healthcare institutions can create a safer working environment for these professionals. Continued research and collaboration among healthcare professionals, regulatory bodies, and researchers will further enhance our understanding of the health effects of IR and contribute to the development of evidence-based guidelines for radiation protection in IC.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://tro.amegroups.com/article/view/10.21037/tro-23-25/rc

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tro.amegroups.com/article/view/10.21037/tro-23-25/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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