There isn’t any such thing as an ordinary life.
– Lucy Maud Montgomery
Sacrifice is part of the great tradition of medicine, a tradition that compels doctors into one of the most hazardous occupations. The list of dangers is actually quite long; risk for communicable illnesses, both common and rare; workplace violence both physical and verbal, stresses that lead to extremely high rates of burnout, depression, substance abuse and suicide that outpace other professions ( of similar level of education, gender, generation) but also some serious occupational hazards and injuries like the radiation injury. Each and every practicing doctor has been touched by these issues, either directly or as witness, however, individuals entering the profession often have limited understanding of the potential long-term consequences that are often understated or ignored.
Interestingly despite this no great effort has been made to study them systematically. Why are we afraid to study data that would establish and quantify the occupational hazards of being a doctor? Some of these hazards have indeed been studied, but there is no comprehensive analysis of workplace risk for physicians like those that have been done for other professions. For example although invasive/interventional cardiology is appropriately focused on quality care/patient outcomes, the risks to the profession have received far less attention. This has resulted in the effects of radiation exposure and/or the protective attire–induced orthopedic injuries being underestimated. As a matter of fact the risks related to the fluoroscopy suite differ significantly from other disciplines in the medical profession. Career terminating orthopedic injuries, cataract formation, life-altering cancers and even vascular injury are subspecialty related. The inordinately high risk of interventional cardiologist themselves developing coronary atherosclerosis and facing its consequences is known to many. Several occupational health groups have addressed these medical concerns for operator and staff, but their voice has been limited.
What is in store for year 2019?
The year 2019 is likely to be different from other years because focus is likely to shift back to caregivers themselves. Several trials are on anvil, results of which are likely to be presented this year. The risk of medical radiation has increased more than 300% over last 25 years or so and radiation protection has become a big challenge now especially in cath labs and other interventional radiology labs. Unfortunately very few data are available in the literature regarding radiation injury and protection. French Society of Medical Physics created a working group in 2017 to establish reference levels for the main procedures realized in these suites using mobile X-ray systems. The report of this group is expected this year and it will publish descriptive parameters for each dosimetric data (KAP, fluoroscopy time, kerma, etc..) and for each category of interventional procedure.
PROTECT Trial - Radioproterctive Light-weight Caps in the Interventional Cardiology Setting
Interest in the risk of brain cancer in invasive cardiologists has been rekindled after a recent report of left-sided brain cancer in primary operators of interventional cardiology procedures. The cap typically worn during invasive procedures is lightweight but provides no significant radiation protection, and is worn only to help maintain a sterile environment. Lead caps can prevent radiation exposure to the head but are heavy to wear. PROTECT Trial will compare the radiation attenuation provided by XPF caps (0.5mm lead-equivalent and 0.3mm lead-equivalent) to the standard protection (fabric cap - no protection) in terms of % radiation attenuation by them during 150 days of fluoroscopy guided cardiology interventions. Another likely outcome is the comparison of the operator comfort of wearing the XPF protection caps versus regular fabric caps.
BRAIN Trial - Brain Radiation Exposure and Attenuation During Invasive Cardiology Exposure
Lead caps have been tested in the past but the relatively heavyweight of lead has limited wide-spread utilization. A novel, lead-free cap, composed mainly of barium sulfate and bismuth oxide, has been developed that has been shown to absorb x-rays but at the same time being significantly lighter than lead. BRAIN Trial using multiple x-ray detectors will test exposure differences between the primary and secondary operators, the left side and right side of the head, and absorption via a lead-free cap.
IC CATARACT Trial - Risk of Radiation-Induced Cataracts Among Interventional Cardiology Staff
Interventional cardiology staff is suspected to have a high prevalence of radiation-induced lens opacities related to radiation exposure. IC CATARACT Trial will report on the prevalence of radiation-associated lens opacities among interventional cardiology staff members (such as physicians, technicians, and nurses) and determine its association with ocupational history.
O'CLOC Study - Occupational Cataracts and Lens Opacities in Interventional Cardiology
The O'CLOC Study will also test the existence of an increased risk of cataracts among interventional cardiologists as compared to cardiologists not exposed to X-rays.
Today, the doctors as well as the nurses and hospital staff across the world greet the New Year and return to their work of caring; caring for their patients, their communities, and humankind in general. However, now they can work with comfort because despite the recent disappointments in the field this New Year is likely to bring focus right back to them and thus in long term provide a solution to various maladies faced by them.
(The writer is professor of Cardiology at AIIMS, New Delhi)