Medical staff at risk from heart procedure X-rays

Heart procedures that involve the use of X-rays may dramatically increase the risk of health problems ranging from cataracts to cancer suffered by medical staff, a study has found.

An X-ray technique called fluoroscopy is routinely used to obtain real-time moving images of the heart. Two common procedures that employ it are coronary angiography, for diagnosing heart problems, and angioplasty to widen narrowed arteries.

Fluoroscopy is used so often that over time the effects of radiation exposure on busy health professionals can be considerable.

Over a 30-year career a cardiologist might receive the dose equivalent of 2,500 to 10,000 chest X-rays.

Researchers have now recorded a catalogue of disorders that are significantly more likely to be suffered by doctors, nurses and technicians involved in fluoroscopy-assisted heart procedures over a typical period of 10 years.

Compared with health workers not exposed to radiation, they were 2.8 times more likely to have a skin abnormality, 7.1 times more likely to develop orthopaedic back, neck or knee problems, and 6.3 times more likely to suffer from cataracts.

Those who had been doing the work for more than 16 years were also three times more likely to develop cancer.

In addition, exposed staff had increased rates of high blood pressure and cholesterol, but relatively low rates of heart disease.

Dr Maria Andreassi, from the National Research Council Institute of Clinical Physiology in Pisa, Italy, who led the study, said: "Occupational doses of radiation in cardiovascular procedures guided by fluoroscopy are the highest doses registered among medical staff using X-rays.

"Interventional cardiologists and electrophysiologists have a two to three times higher annual exposure than that of radiologists, as they are closer to the radiological source and experience radiation exposure with the patient, whereas diagnostic radiologists are generally shielded from radiation exposure."

The biological effects of radiation exposure are measured in millisieverts (mSv).

Dr Andreassi said each year a busy cardiologist or electrophysiologist was exposed to around 5mSv of radiation. Over a 30-year career they might be exposed to 50 to 200mSv, the same dose they would receive if they underwent 2,500 to 10,000 chest X-rays.

The findings, published in the American Heart Association journal Circulation: Cardiovascular Interventions, are from a survey of 466 individuals employed in hospital cardiac catheterisation (cath) labs and 280 professionals who worked in other settings.