A session held yesterday at the Charing Cross International Symposium revealed that there is a widespread lack of physician awareness about the dangers of radiation in the interventional suite. The effect of exposure to radiation has become particularly important with the move from open to endovascular procedures, and delegates heard how no single specialty had a monopoly on bad practice when it came to radiation.
During the session it became apparent that the knowledge base about radiation had not been developed and incorporated into training and that appropriate behaviour in the interventional suite was often ignored, leading to operators receiving unnecessary doses of radiation. Surgeons, who have belatedly started using radiation, interventional cardiologists, interventional radiologists and radiologists are all guilty of bad practice, delegates heard.
“We are not aware of how badly affected we can be and this session turns the spotlight on how little we know. It is very important to become aware and realise the danger before you can start steps to reduce it. Perhaps as a profession we are not doing enough,” said Roger Greenhalgh, London, UK, chairman of the symposium.
Lindsay Machan, Vancouver, Canada, who was invited to comment on the Radiation Exposure session, told delegates that there were “two dirty little secrets” about radiation that he wanted delegates to pay attention to. “The first is that there is no safe dose of radiation; the idea that there is a threshold has now been debunked. The second is that every person in this room has a variant level of the radiation repair genes and there is no test as yet for the repair genes.”
Machan referred to the results of a long-term international study of thousands of workers exposed to radiation in the Chernobyl disaster in 1986, which found that the disaster clean-up crew, no matter where they were located, had the same incidence of cataracts, dispelling the idea of there being a threshold for cataract development. Referring to the outcomes from another 20-year study published by Chodick et al in the American Journal of Epidemiology in 2008 that found that there was no apparent threshold level for technologists to get cataracts, he said: “Everything that you hear about thresholds is absolutely not true. Treat radiation like iodinated contrast and use only as much as needed and no more.”
Machan also told delegates about the work of the late Basil V Worgul, New York, USA, which had shown that there was a possibility that the human population included genetically predisposed radiosensitive subsets.
“Everybody in this room has some degree of radiation damage and not everyone has complex innovations available to help them reduce the dosage. However, the distance from the tube and the importance of magnification cannot be overstated,” Machan said.
A member of the audience referred to currently available tools that enabled the visualisation of dosage in the form of a light or sound alarm. “Everybody wants to avoid radiation, they are just not aware of how their behaviour impacts dose. So if you stand unnecessarily close to the machine, there is an immediate warning and this can teach operators a lot,” he said.
Operator behaviour is driven by various factors
“You cannot overstate the importance of a real time reminder of the dose. Another important thing we have observed is that when our nurses and technologists became aware of their own risk, it changed the dynamic quite considerably. Operators are driven by a different dynamic; we want to get that procedure done, we want to show the photos and have a tendency to ignore