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February 11, 2020

SCAI Multisociety Position Statement Addresses Occupational Health Hazards in Catheterization Labs

February 11, 2020—The Society for Cardiovascular Angiography & Interventions (SCAI) multisociety position statement on occupational health hazards of the catheterization laboratory has been published by Lloyd W. Klein, MD, et al online in SCAI’s Catheterization & Cardiovascular Interventions.

Noting that radiation exposure is inherent to procedural performance in the fluoroscopic laboratory, the document reviews the risks and injuries involved in radiation exposure, as well as the orthopedic impact of wearing heavy leaded aprons to protect from radiation and the problems associated with poor ergonomic postures required by the design of the catheterization laboratories.

According to the authors, the goal of the document is to foster a comprehensive “culture of safety” in the fluoroscopic laboratory, including a review of optimal procedural practice with processes and training to minimize injury; novel equipment to enhance protection; and shielding systems to reduce operator radiation exposure. The document discusses the role of the physician and professional societies, industry, and hospitals in these efforts.

In Catheterization & Cardiovascular Interventions, the document outlines the following “best practices” that professional societies should encourage to assist their members:

  • Understand the evidence demonstrating the risks of occupational radiation exposure, including both possible direct (cataracts, cancer risk, cardiovascular) and indirect (orthopedic injury) hazards.
  • Champion use of protective measures, including proper use of shielding, and minimize unnecessary radiation usage in the laboratory.
  • Ensure consistent application and adherence to established training and procedural processes.
  • Insist on accurate monitoring of operator and laboratory personnel exposure.
  • Encourage widespread adoption and utilization of new technologies for the reduction of occupational hazards.
  • Acknowledge that current advocacy efforts have been inadequate, and participate in more robust effective advocacy initiatives on behalf of the members.
  • Undertake further efforts with industry, including encouragement and support to further develop effective equipment that fosters/facilitates enhanced safety and protection in the workspace, including fluoroless laboratories.
  • Support individual physicians and practices to work with hospital administration to ensure worker safety.
  • Initiate formal training programs to minimize the hazards of radiation exposure that should become mandatory for a laboratory’s certification.
  • Commit to playing a leadership role in correcting these deficiencies and establishing a culture of safety.
  • Assist hospitals and health systems to establish comprehensive programs for clinician health in the catheterization and electrophysiology laboratories that are consistent with recommended wellness programs.
  • Use this issue as an opportunity to share and collaborate with international colleagues.

Additionally, the document provides the following future policy directions:

  • Operators should receive consultation by an ergonomics specialist to optimize posture, positioning, and equipment that might reduce orthopedic impact.
  • Each laboratory should create and enforce policies and processes to assure continued operator education on best practices for radiation reduction and protection.
  • Hospitals (and other facilities) should upgrade imaging equipment (hardware and software) and radiation‐producing equipment to take advantage of the newer technologies that may significantly reduce radiation exposure, including investment in enhanced shielding.
  • Clinicians and professional societies should support research, education, and advocacy efforts to advance the field of occupational safety and health.
  • Hospitals should purchase their employees (including fellows, nurses, techs, and physicians) protective goggles/eyeglasses (including prescriptions and bifocals where needed), personalized lead aprons (with shoulder shields when requested), and lead caps (if requested).
  • Other protective equipment such as disposable radiation shielding pads should NOT be refused by hospitals due to their expense.
  • Catheterization laboratories should implement evidence‐based strategies/tools to reduce radiation exposure and decrease orthopedic burden.
  • We should continue to acquire high‐quality data to validate occupational hazards and the benefits of devices designed to mitigate them.

According to the authors in Catheterization & Cardiovascular Interventions, future processes and proposals to improve the fluoroscopic laboratory environment should be based on the following precepts:

  • There are ample clinical data documenting the prevalence of serious occupational health risks engendered by the fluoroscopic laboratory environment.
  • Sufficient attention to these occupational health issues has been drawn in annual meetings and published clinical scientific studies.
  • Despite these data and advocacy efforts, advances to improve worker safety in the fluoroscopic laboratory remain inadequate.
  • A concerted effort by all stakeholders (physicians, catheterization laboratory nurses, technologists, sonographers, hospitals, professional societies, industry) in the fluoroscopic laboratory is necessary to further advance occupational safety and health.

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