A Call to Reduce the Physical Burden of the Cardiac Cath Lab
It doesn’t take more than a few days working in the cath lab to recognize many of the risks and physical burdens that will affect you as you move forward in your career. Daily exposure to radiation, a cumbersome lead apron, and subpar design of equipment and procedure rooms drive the most substantial occupational hazards we deal with as interventionalists.
On average, the career of an interventional cardiologist will range from 35 to 40 years. In a rough calculation, say you spend 30 hours a week in the cath lab. That translates to more than 1,500 hours a year—or more than 54,000 hours over the course of a career, give or take with vacation and other duties—of direct physical burden. Data now strongly indicate that over time, working in the lab while wearing a lead apron is associated with orthopedic health risks, particularly in the neck and spine. These injuries can result in missed days of work for rest or even surgery.
Additionally, the design of interventional suites has drastically changed in the last 20 years, but it is still doesn’t promote convenience for practicing cardiologists. With the growing interest in and volume of structural heart disease procedures, procedural time has lengthened and the number of required staff has increased. Moreover, radial access and the use of ultrasound to gain arterial access are becoming more common to minimize bleeding complications. However, because patient tables are currently designed for femoral access, radial cases require the interventional cardiologist and laboratory staff to invent creative ways of supporting the patient’s arm, often sacrificing operator posture and radiation risk.
The standard lead apron currently in use can weigh anywhere from 9 to 14 pounds, with a design that hasn’t changed in the last 30 years. Something is wrong with that. The interventional cardiology societies should encourage medical device companies to prioritize the development of new apron designs with lighter weights and perhaps built-in radiation monitors. We’ve seen the development of two-piece aprons with a skirt designed to lower the load on the shoulders, but we need more innovation.
It’s easy to leave the lab internally satisfied with your great clinical work but externally miserable and achy. On the other hand, the lead is supposed to protect us from harmful radiation, which is an invisible threat. But where do we draw the line between unknown and tangible risks? Is our long-term health more important than our short-term sanity?
In the end, we have to take responsibility for our own actions. We should be organizing sessions at local and national meetings that promote neck and back stretching exercises for cath lab workers. Exercise balls and mats should also be made available in cath lab changing rooms, and maybe we should consider screening for orthopedic issues on a regular basis. Research in this arena is minimal at best, and a society-supported outcomes and cost-effectiveness study could set precedence for updating cath lab best practices.
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