SCAI multi‐society position statement on occupational health hazards of the catheterization laboratory: Shifting the paradigm for Healthcare Workers' Protection

摘要

Renewed attention has focused on the occupational health hazards posed by working in the fluoroscopic laboratory.1-6 Accumulated occupational radiation exposure is associated with health risks to physicians, nurses, and technologists working in this environment. Health care workers are subject to insidious health effects of radiation exposure over many years. Adverse effects include the established predilection to posterior subcapsular cataracts, as well as worrisome signals of lifetime risks of cancer induction, particularly in the unprotected brain.7-12 A further consequence is the extensively documented incidence of orthopedic illnesses reported in physicians as well as nurses and technologists and injuries linked to the cumulative burden of bearing the weight of only partly protective lead aprons mandatory to reduce radiation risk.13-16 The increased volume and complexity of procedures, together with the physical stresses inherent in procedural performance, have exacerbated the prevalence and magnitude of such orthopedic injuries.17 The high prevalence of orthopedic afflictions not only affects individual health but also could be potential career ending, with workforce implications for both the profession as well as for society.15 Advances in interventional imaging techniques and treatments over the last three decades have achieved significant success with clear benefits to our patients18; yet protective measures for workers have unfortunately lagged the pace, magnitude, and impact of this therapeutic progress. The purpose of this position statement is to review the data documenting occupational health injuries, summarize current equipment and processes that can be widely applied to optimize protection, emphasize the importance of investment by hospitals and health systems in protective equipment established to enhance workplace safety, examine barriers that need to be overcome to spur advances to enhance the occupational safety of the fluoroscopic laboratory environment, and propose enhanced advocacy for innovation. Future processes and proposals to improve the fluoroscopic laboratory environment should be based on the following precepts: (a) there is ample clinical data documenting the prevalence of serious occupational health risks engendered by the fluoroscopic laboratory environment; (b) sufficient attention to these occupational health issues has been drawn in annual meetings and published clinical scientific studies; (c) despite these data and advocacy efforts, advances to improve worker safety in the fluoroscopic laboratory remain inadequate; and (d) a concerted effort by all stakeholders (physicians, catheterization laboratory nurses, and technologists, sonographers, hospitals, professional societies, and industry) in the fluoroscopic laboratory is necessary to further advance occupational safety and health. Radiation exposure is inherent to procedural performance in the fluoroscopic laboratory. Exposure to ionizing radiation imposes health risks to both patients and operators, resulting in an increased likelihood of numerous illnesses and diseases.1-8 The association with posterior subcapsular cataracts is well documented.11, 12 There are growing concerns for cancer induction,7, 8 with recent reports of a cluster of predominantly left-sided brain cancers in interventionists,9, 10 as well as a signal for increased breast19-22 and skin cancers.23-26 Radiation exposure generally, not necessarily as part of occupational exposure, is associated with leukemia/lymphoma, myeloma, numerous gastrointestinal and bone cancers, and thyroid and parathyroid adenomas. These disquieting signals fuel the increasing anxiety regarding radiation exposure-related oncogenesis, though no mortality impact has been proven.27 Recent studies have also suggested that occupational radiation exposure is associated with hypertension, hypercholesterolemia, and possibly atherosclerosis.28-30 Evidence of lengthening sarcomere length and early vasc