SCAI Consensus Document Addresses Radiation Exposure Safety in CCL

February 2, 2011—The Society for Cardiovascular Angiography and Interventions (SCAI) announced publication of a consensus document concerning radiation exposure to pregnant physicians and technical staff in the cardiac catheterization lab (CCL). Patricia J. M. Best, MD, et al of SCAI's Women in Innovations (WIN) group published the paper in Catheterization and Cardiovascular Interventions (2011;77:232–241).

According to SCAI, the complexity of minimally invasive procedures continues to increase, requiring greater fluoroscopy time and increased chance of radiation exposure to medical staff.

The paper addresses reservations about the safety of female interventional cardiologists, technicians, and nurses exposed to radiation in the CCL during pregnancy—an issue that many researchers believe has contributed to a disparity in the number of women who practice in the field.

Currently, women now account for 49% of all medical students and 44% of all internal medicine residents. However, only 18% of cardiology fellows are women, with only 8.7% in interventional cardiology fellowships. A recent survey found 24% of women name radiation exposure as a reason to alter a career plan in cardiology to a more minimally exposed field.

According to the paper, current scientific data show fetal radiation exposure in the CCL is very low, and there is no significant increased risk to a fetus in pregnant women working in the CCL. Data also show no increased risk for side effects associated with radiation exposure in utero such as childhood cancer, mental retardation, reduced intelligence quotient, or pregnancy loss.

“Maintaining the safety of our patients and staff is always our number one priority,” commented Dr. Best. “Radiation exposure is a very legitimate concern in our industry, but standard safety guidelines, protocols, and tools have been designed to ensure radiation exposure is kept to a safe minimum in all staff and patients, regardless of gender.”

Dr. Best added, “We hope this paper encourages women considering a career in interventional cardiology to review the available scientific data and make an informed career choice. We also encourage institutions to make their radiation safety policies clear to all staff in an effort to ease women's fears about any occupational exposure they may encounter.”

Even with promising scientific data suggesting no increased risk to the fetus from occupational radiation exposure, the paper reinforces that pregnant physicians, technicians, and nurses should take appropriate measures to reduce radiation exposure, including:

• Completing formal education and training in radiation protection
• Notifying proper institutional radiation safety personnel of pregnancy to ensure adequate monitoring
• Using lead shields and personal protective equipment, including maternity lead or lead-equivalent protective garments
• Using a direct reading dosimeter and radiation monitoring badge, worn at the waist level under the lead garment, in addition to the typical radiation monitoring badge worn at the collar

The paper also addresses legal issues surrounding exposure protections, reinforcing that in the United States all exposure protection policies must be applicable to all employees, regardless of age, gender or pregnancy. Still, many institutions enact their own policies prohibiting women from working near radiation after revealing pregnancy. The Women in Innovations writing group and SCAI discourage that practice because it may prevent women from disclosing their pregnancy status, thus hindering proper monitoring of radiation exposure during pregnancy.