Operator, Protect Thyself: SCAI Sessions Urge More Self Awareness of Radiation Risks

ORLANDO, FL—At least a dozen interventional cardiologists attending the SCAI 2016 meeting here yesterday lined up to wait for free eye exams as part of a research and prevention effort being done amid ongoing concerns about radiation exposures in the cath lab. Earlier in the day, presentations had spread the word on measures to reduce exposure and urged operators to settle for nothing less than the lowest possible levels. 

The eye exams are part of the iC-CATARACT program headed by Emmanouil S. Brilakis, MD, PhD (Dallas VA Medical Center, Dallas, TX), who told TCTMD that he was pleasantly surprised by the popularity of the screening effort.

“We’ve been humbled,” he said. “We expected people would be interested but not that interested. The first day [of exams] was supposed to be only 2 hours and ended up going for 5 hours. I think it’s something people are worried about, and it’s a good opportunity while they are here to get their eyes checked.”

The screening involves SCAI attendees taking about 5 minutes to fill out a questionnaire about individual radiation exposure over the years, having their eyes dilated, and then waiting about 15-20 minutes for the eye exam.

The goal of the project, Brilakis said, is two-fold. If individuals find out during the screening process that they have the beginning of a cataract “it’s an extra bell that you should change something in your practice to make sure that it doesn’t get any worse,” he said. Secondly, his group hopes to collect data similar to what has already by collected by other groups such as SOLACI, the Latin American Society of Interventional Cardiology, who have reported a 30 to 50% prevalence of cataracts among practicing interventionalists.

“We really want to try to understand how big the problem is here in the US,” he observed.

Interventionalists Not Yet ‘Getting It’

In an early-morning session aimed at radial practitioners, Sanjit S. Jolly, MD, MSc (McMaster University, Hamilton, Canada), urged more self-awareness of radiation-protection measures in the cath lab and among colleagues.

“We often see [in] our first-year fellows that as they take their pictures they lean in to see really well,” he said. “I tell them that’s the exact opposite [of what you should do]. When you step on the cine pedal you need to take a step back, and then as it loops you can put your face right next to the monitor.”

Other simple measures, he noted, include side protection, minimizing magnification, and having your center’s radiation physicist periodically watch you as you practice to make sure you are not leaving noticeable gaps in protection.

Newer technologies, he added, have allowed for reductions in fluoroscopy to 7.5 frames per second (FPS) without compromising image quality, while novel automatic dose reduction systems have shown promise for reducing air kerma by about half. “The challenge, of course, is for those who have used 7.5 frames oftentimes it’s very difficult to see, especially in large patients,” Jolly said.

Another simple measure that is still not being widely embraced, he added, is lightweight lead caps, which have been shown to cut radiation to the operator by 81%. But a show of hands after Jolly’s presentation found that few audience members acknowledged use of both 7.5 frames and a lead cap.

Commenting on the informal survey for TCTMD, Brilakis said interventionalists still are not “getting it” that radiation needs to be minimized as much as possible for every procedure.

“If I walk into the lab and see the picture is extremely clear I know it’s the wrong setting—this is 15 FPS—and I immediately turn it back,” he said. “There are very few cases where you need super-high resolution.”

Another possible solution to the radiation exposure problem is robotic-assisted PCI. Describing his own experience with the remote-controlled technology in a separate session, Giora Weisz, MD (Shaare Zedek Medical Center, Jerusalem, Israel), said the ability to take more precise measurements helps avoid geographic miss. In one study, he noted, geographic miss fell from 55% with manual PCI to 9% with robotic PCI. Plus, it has the advantage of a relatively swift learning curve, particularly for those who grew up playing video games, and relieves the physical stress of needing to wear heavy lead aprons and to stand throughout procedures.

Most importantly, Weisz said, patient care is not compromised and procedure time is not prolonged compared with manual PCI, noting that “last time I checked, the interventional cardiologist was still a human being and deserves to be protected.”

Disclosures:

• Jolly reports grant support or honoraria from Medtronic, Astra Zeneca, and St Jude.
• Weisz reports relationships with multiple drug and device companies. 

Related Stories:

• Survey Adds To Mounting Evidence That Cath Lab Work Has Radiation-Related Health Effects
• Tumors, Bad Backs, and Cataracts: Interventional Physicians Face a Lifetime of Risk
• New SCAI Survey Shows Interventionalists Still Plagued by Occupational Health Hazards