From the March 2016 issue of HealthCare Business News magazine
By: David Handler, Contributor
Coronary artery disease is the leading cause of death in America. Percutaneous coronary intervention (PCI), commonly known as angioplasty, is the most common treatment, with more than 900,000 procedures performed annually in catheterization laboratories across the country. Despite improvements in the devices used in cath labs, the actual procedure has remained largely unchanged for nearly 40 years. While standing over the patient, an interventional cardiologist snakes wires and catheters up from either the femoral or radial artery, reaching the heart to re-open blocked vessels. Often, a stent is inserted to keep the artery open. The procedure uses X-ray (fluoroscopy) to visualize the patient’s anatomy, placing the physician within feet of a radiation source for every procedure.
Physicians frequently spend six or more hours daily in procedures, wearing 20 pounds of lead aprons in an attempt to protect themselves from ionizing radiation emitted by fluoroscopy. Angioplasty saves patients’ lives, but there is a mounting body of evidence highlighting the significant occupational hazards physicians face in the cath lab. Leading hospitals in the country, including the recent installations at the Mayo Clinic and Massachusetts General Hospital, have implemented a vascular robotic system to refine the procedure and decrease occupational risks for physicians and staff. Let’s look at what hospitals should consider when evaluating robotic technology for the cath lab.
Long-term health for cath lab workers
Occupational exposure to low-dose ionizing radiation has been shown to have many health consequences for interventional cardiologists, who receive the highest amounts of radiation of any medical professional.
Brain tumors: Over a career, interventionalists receive 1,000 mSv exposure to the head, equivalent to 50,000 chest X-rays. Increased exposure to radiation may cause incidents of cancer, specifically brain tumors. One study of self-reported brain tumors in interventionalists showed that 86 percent of those tumors were left-sided, the side of the head most exposed to radiation during procedures.
Orthopedic injuries: Heavy-leaded personal protective equipment worn for radiation protection may result in orthopedic injuries. The incidence of spine issues for interventionalists practicing over 21 years is 60 percent.
Cataracts: Cataracts are reported as another effect of radiation exposure in interventionalists. In the RELID study, 50 percent of interventional cardiologists had posterior subcapsular lens changes (precursors to cataracts, caused by radiation exposure) versus less than 10 percent in the control group.
