New SCAI Survey Shows Interventionalists Still Plagued by Occupational Health Hazards

Half of interventional operators experience some form of orthopedic injury, and about 1 in 10 have had to take a break from the cath lab due to a health-related issue. The findings, from a survey conducted by the Society for Cardiovascular Angiography and Interventions (SCAI), were published online March 24, 2015, ahead of print in Catheterization and Cardiovascular Interventions. 

“We know that a lot of our colleagues have had orthopedic problems, so it’s not a surprise to us that this is an issue,” lead author Lloyd W. Klein, MD, of Advocate Illinois Medical Center (Chicago, IL), told TCTMD in a telephone interview. “The importance of a survey like this is to be able to acquire [data] so that we can talk with our societies, employers, and practice managers and show them that there are hazards to what we do that need to be considered.”

Dr. Klein and colleagues contacted all 2,710 active members of SCAI from late September through mid-October 2014. The online survey included questions related to duration of invasive practice, procedural volume, injury/illness history, radiation safety measures, and preferred retirement age. A previous SCAI survey was done in 2004.

Among 310 responders (mean age 49 years; 92.0% male), the mean length of practice was 16 years and 28.1% had been in practice for more than 25 years. Mean annual volume was 380 for diagnostic procedures and 200 for interventional cases of all types.

Physical Challenges Widespread

Overall, 6.9% of operators reported limiting their personal caseload due to radiation exposure and 9.3% reported taking a health-related leave of absence. Of those aged 61 to 70 years, 36.4% said they had limited their caseload and 35.7% had taken an occupational health-related break. Radiation-related illnesses included skin problems (4.8%), cataracts (5.5%), and hematologic and cancerous diseases (4.8%). However, 18.5% of those surveyed said they occasionally neglect to wear their radiation badges and 28.6% reported never doing so.

Notably, 49.4% of responders reported orthopedic injuries; in total, 24.7% noted cervical spine disease; 34.4% lumbar spine problems; and 19.6% hip, knee, or ankle joint problems. While there was no association between caseload volume and the specific type of orthopedic disease, operators reporting annual caseloads of greater than 900 were more likely to have such problems.

Interventionalists were more apt to report orthopedic problems if they were older and had been in practice longer (P < .001), with age being the strongest correlate for cervical, hip/knee or ankle, and lumbar injuries as well as any orthopedic illness (P < .0001 for all). In addition, on multivariate analysis, total annual caseload was strongly associated with reports of orthopedic problems.

Nearly all respondents said they knew at least 1 or more colleagues who had been affected by an orthopedic work-related injury, and 29% reported knowing colleagues with hematologic or other cancers, including 4.2% who mentioned brain cancer.

With regard to radiation protection, the majority of responders reported incorporating only 2 new technologies: lightweight lead (71.9%) and low-dose imaging systems (55.3%). More than 30% reported using some sort of cranial protection, but less than 10% said they use zero-gravity systems, shielded gloves, or vascular robotic technology. However, 93% expressed openness to adopting new, even awkward, technologies if they offered improved radiation protection.

Interestingly, 37.5% of responders supported putting a lifetime cap on radiation exposure, after which retirement from cath lab practice would be mandatory or strongly advised.

No Net Gains Over the Past Decade

The current findings are consistent with the 2004 SCAI survey and “[document] a substantial prevalence of orthopedic complications with no discernible improvement, and apparently an actual increase, among active interventional cardiologists,” the authors write. Dramatic changes in practice since that time, including increases in procedural case volume, procedural time, case complexity, and patient difficulty, appear to have offset efforts to reduce operator stress and radiation exposure, they add. 

Moreover, Dr. Klein told TCTMD that interventionalists do not take as good care of themselves as they could. “Despite the fact that in the last 10 years people have come up with various solutions to issues, very few operators are using them,” he noted. 

Looking solely at numbers, “the orthopedic problem is the biggest,” he said. “Cancer is much less numerically of a problem…, but a survey is going to be weak for finding that because obviously if you're dead, you’re not going to be answering a survey.”

Ajay J. Kirtane, MD, SM, of Columbia University Medical Center (New York, NY), said he had been unaware that orthopedic injuries were “really that prevalent” among interventionalists. However, he told TCTMD in a telephone interview that after he began experiencing work-related aches and pains, he started exercising more and practicing yoga. 

With regard to behavioral strategies like core strengthening, shifting positions in the cath lab, and wearing supportive shoes, “no one ever gives you an education on this,” Dr. Kirtane said. “As long as there's awareness of these things, then people can actually start to take initiatives to prevent them.”

Expensive cath lab additions can be a harder sell, he said. “When you try to make the proposition to a hospital administrator, [you are asking for] a million-dollar capital cost. But if it's for your own safety, perhaps that's something that should be entertained.”

Risks Leading to Early Retirement

The notion of mandatory retirement based on cumulative radiation exposure is somewhat controversial, Dr. Kirtane said, suggesting that it should be a personal choice, even given certain liability issues. “There are a lot of people who practiced in a period where the radiation dosage was higher, the shielding wasn't nearly as good, and the education was nonexistent…, and they don't have issues,” he said, adding that if the risk was more “deterministic,” he might support mandatory retirement.

Dr. Klein said he found it interesting that most responders aim to retire from lab work in their 60s. “Doctors could really work into their 70s if they keep up, they want to, and they're healthy,” he commented, suggesting some people may not want to deal with the physical challenges when they reach a certain age.

The fact that only 2% of the respondents were in their 70s “tells you that not only do people want to retire in their 60s, but they are in fact retiring in their 60s,” he added.

Making the Case to Employers

Even though advances have been made in improving radiation safety and decreasing occupational hazards, “what has been done up until now isn't working,” Dr. Klein said. “We have to be able to push back [against] our employers—the hospitals, the practice managers, the administrators—and be able to say to them, ‘Look, this is not a healthy working environment and we really want to be protected or we're going to not work as much in there.’”

Many doctors may shrink from taking that step out of the fear of losing their jobs, he acknowledged. So to protect individual physicians, cardiology societies should create an evidence-based policy for a healthy work environment that operators can stand behind, he proposed. “[That way,] it doesn't seem like they're being bad employees.”

Disclosures:

• The study was sponsored by Corindus.
• Drs. Klein and Kirtane report no relevant conflicts of interest.

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