Societies Urged to Establish and Demand Best Practices for Cath Lab Safety

Improving safety for everyone who works in a cath lab can only be achieved if professional societies come together and oversee the creation of nationally recognized regulations for occupational health protection, a new multi-society position statement asserts.

The document, initiated by the Society for Cardiovascular Angiography and Interventions (SCAI) and endorsed by the American College of Cardiology (ACC) Clinical Policy Approval Committee, the American Society of Echocardiography (ASE), and the Heart Rhythm Society (HRS), covers a range of concerns that affect physicians, nurses, and technologists. These include the lifetime risks of cataracts, cancer, and orthopedic injuries.

“First of all, professional societies have to teach their members that this is really an issue. One of the problems that we've had in the past is that young cardiologists really don't think this applies to them,” Lloyd W. Klein, MD (University of California, San Francisco), lead author of the statement, told TCTMD. “Then the societies have to establish standards for what protection is, so that hospitals can't say ‘well, that costs too much money.’ You have to have rules and regulations that everybody has to follow. And the third part of it, is they then have to help the leader physicians at each institution talk to hospital administrators and say this is not optional.”

The position statement, published online February 11, 2020, in Catheterization and Cardiovascular Interventions, recommends a dozen ways that professional societies should advocate for best practices. These include understanding the evidence demonstrating the risks of potential direct and indirect occupational radiation exposure, championing the use of protective measures such as proper shielding and minimizing unnecessary radiation, ensuring consistent adherence to training and procedural processes, insisting on accurate monitoring of operator and staff radiation exposure, and reaching out to industry to encourage and support their efforts to both develop safer equipment and to reconfigure cath labs to be safer, healthier work spaces.

One of the problems that we've had in the past is that young cardiologists really don't think this applies to them. Lloyd W. Klein

Klein said things like partnering with non-clinicians, such as ergonomic specialists and software and hardware developers, may open many people’s eyes to how current cath lab configurations are harmful and can be greatly improved without compromising efficiency.

“Once we know what best practice ought to be, then we have to go to industry and say we've studied this and we have to change the whole cath lab design and we need you to start making labs that fulfill the necessary steps in order for us to do that,” he told TCTMD. “If you look at kitchens, and military airplanes, and cars from the 1950s, the designs have changed. “Yet, the cath lab of the 50s and the cath lab of today are not that much different.”

Emphasis on Minimizing Hazards, Protecting Future Generations

The document also offers insight into future directions that will require professional societies to be involved in supporting an ongoing ‘culture of safety’ for cath lab workers. This includes recommendations that hospitals and other facilities upgrade imaging and radiation-producing equipment and invest in newer technologies such as enhanced shielding. It also recommends that clinicians and professional societies support research, education, and advocacy efforts to advance the field of occupational safety and health, as well as actively work to acquire high-quality data that validate occupational hazards in the cath lab and demonstrate the benefits of devices designed to mitigate harm. The document also calls on hospitals to purchase protective goggles/eyeglasses for their employees, including fellows, nurses, techs and physicians.

“I think in order for the field to move forward, in order for there to be protection for everyone, ACC, SCAI, and others need to make clear what their requirements are for protection,” Klein said.

In the paper, he and his co-authors write that industry and physicians “must partner to expedite development of a fluoroless catheterization laboratory, using echocardiography, magnetic resonance imaging, 3D mapping, or other technologies. Removing the necessity of lead aprons should be the ultimate goal.”

To TCTMD, Klein said he believes many established interventionalists, including himself, feel an obligation to get these changes made to protect the next generation and to preserve diversity in the workforce, noting that “radiation exposure concerns have sometimes been considered a reason for disproportionately low representation of women in the field.”

The position statement is dedicated to the memory of radiation safety proponent and co-author Charles Chambers, MD. “Charlie was a real motivating force in all this,” Klein said. “I think his passing has left an even bigger vacuum . . . and [many of us] feel the need to be its voice now.”