ALARA+ Safety Standard Proposed to Reduce Radiation and Injury Risks in Catheterization Labs

March 24, 2026—Nine leading medical societies have issued a call for updated safety standards in fluoroscopy laboratories, where clinicians performing minimally invasive procedures face radiation exposure and orthopedic injuries from heavy protective equipment.

The societies advised that a report by Arash Salavitabar, MD, et al (“ALARA+: Summit on Radiation and Orthopedic Risks in Fluoroscopic Laboratories”) details the health, financial, and workforce impacts of fluoroscopy-guided settings and proposes the enhanced safety framework of ALARA+ (“as low and as light as reasonably achievable”). The report was published simultaneously in JSCAI, Heart Rhythm, Journal of Vascular and Interventional Radiology, and Journal of Vascular Surgery–Vascular Insights.

Robert F. Riley, MD, was Chair of the 2025 Summit on Radiation and Orthopedic Risks in Fluoroscopic Labs; Arnold H. Seto, MD, was Co-Chair.

“How we think about radiation safety has been historically guided by the ALARA principle, or ‘as low as reasonably achievable,’” commented Dr. Riley in the press release. “But that approach has proven to be not safe enough for health care staff working in fluoroscopic labs.”

He continued, “Traditional ALARA principles focused on incomplete methods of minimizing radiation exposure. Additionally, they did not fully account for the orthopedic strain caused by wearing heavy lead protective equipment during long procedures. The new framework, ALARA+, calls for responsible protection strategies that are ‘as low and as light as reasonably achievable’ for the entire team.”

The multisociety summit report addresses the dual occupational hazards linked to fluoroscopic procedures—radiation exposure and orthopedic strain from traditional protective equipment—and aims to ensure that safety is built into the environment, equipment, and standard of care, noted the press release.

As outlined by the societies, the report calls for several actions to improve safety in fluoroscopy laboratories, including the following:

• Accelerating the adoption of modern radiation protection technologies, such as suspended, freestanding, or table-mounted shielding systems that reduce exposure without requiring clinicians to wear heavy protective garments
• Expanding real-time radiation monitoring to enable clinicians to receive immediate feedback and reduce exposure during procedures
• Strengthening education and training in radiation safety and exposure reduction for physicians, trainees, nurses, and technologists
• Continuing technological innovation to protect all catheterization lab clinicians
• Supporting regulatory and accreditation standards that promote safer fluoroscopy laboratory environments

According to the press release, the report is endorsed by the Society for Cardiovascular Angiography and Interventions, American College of Cardiology, Alliance for Cardiovascular Professionals, American Society of Echocardiography, Heart Rhythm Society, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society of Vascular and Interventional Neurology, and the Society for Vascular Surgery.