Radiation exposure and orthopedic injury have long been considered “part of the job” in fluoroscopy labs. But leading medical societies say it’s time to change that, urging mandatory safety improvements in a new statement. Medscape Medical News spoke with the first author of the statement, David G. Rizik, MD, about changing these conditions.

What developments in practice, or regulation, made you feel this was the moment to push for a more formal, multisociety consensus on enhanced radiation protection?

Over the last decade, we’ve seen a surge in robust data documenting the health risks of chronic, low-dose radiation exposure, not just for operators, but also for the entire team in the lab.

At the same time, technological advances have produced highly effective enhanced radiation protection devices (ERPDs), yet adoption remains patchy. Voluntary guidelines haven’t moved the needle. We’re still seeing unacceptably high rates of radiation-associated cataracts, neoplasms, and musculoskeletal injuries among interventionalists and staff (secondary to use of an archaic, burdensome lead apron).

Meanwhile, regulatory bodies have begun to update exposure thresholds in light of new evidence, but implementation is inconsistent and enforcement is rare. The convergence of compelling epidemiologic data, technological readiness, and a clear gap between evidence and practice made this the right moment for a unified, multisociety mandate.

You emphasize moving beyond the ‘annual lecture’ model toward sustained training, observation, and feedback. Can you walk us through what an ideal radiation safety program looks like in a busy cath lab — who’s involved, and what changes day to day?

An ideal program is built on three pillars: continuous education, real-time feedback, and shared accountability. It starts with onboarding every new team member, from physicians to technologists and nurses, [making sure each] receives hands-on training in radiation safety and device use.

But it doesn’t stop there. Daily huddles include quick reminders about shielding and positioning. Real-time dosimetry and feedback systems are in place so operators can see their exposure in the moment and adjust accordingly. Peer observation and periodic walk-throughs by a radiation safety officer or physicist ensure that best practices aren’t just theoretical, they’re happening at the table.

The culture shifts from compliance to commitment: Everyone owns radiation safety, and it’s woven into the daily routine.

ERPDs aren’t reimbursable and require capital investment. When hospital leaders say, ‘We can’t afford this,’ what is your response, ethically, from an as low as reasonably achievable (ALARA)/regulatory standpoint and in terms of long-term institutional liability?

Ethically, we have a duty to provide a safe working environment. The ALARA principle isn’t just a regulatory phrase. It’s a moral imperative.

Regulatory agencies are increasingly aware that failure to provide adequate protection exposes institutions to significant liability. Lawsuits related to occupational hazards, especially when there’s clear evidence of preventable harm and available technology, can be very costly.

Moreover, the long-term costs of disability, attrition, and recruitment far exceed the initial investment in ERPDs. Inaction is not truly saving money — it’s deferring much greater costs, both financial and human, down the road.

You describe a ‘second epidemic’ of musculoskeletal injury from heavy lead, with very high rates of spine disease and orthopedic symptoms among interventionalists and staff. How do you see ERPDs and new shielding approaches changing the culture of the cath lab in terms of career longevity, burnout, and recruitment into interventional cardiology — especially for younger and women cardiologists?

The traditional culture has been to “tough it out” through pain and injury, but we now recognize the enormous toll, career-ending spine surgery, chronic pain, and early burnout. ERPDs and advanced shielding allow us to finally break this cycle.

By removing or minimizing the need for heavy lead, we can make interventional careers more sustainable and appealing, particularly for younger physicians and women, who may be disproportionately affected by ergonomic challenges and concerns about radiation during childbearing years.

This shift is essential not just for protecting current practitioners but also for attracting the next generation to our field and ensuring a diverse workforce.

Finally, the statement notes that state regulations and shielding requirements vary widely, and that this can complicate system-wide adoption of ERPDs. For cardiologists working across different states, what are the most practical steps to navigate those regulatory differences and still move toward a ‘no-lead’ or minimal-lead environment?

The regulatory patchwork is a real challenge, but the best way forward is to set your own internal standard; one that meets or exceeds the most stringent requirements you might encounter.

Advocate for system-wide policies that prioritize safety over mere compliance. Engage hospital leadership and risk management teams to create uniform protocols, regardless of state-by-state variation. Leverage multisociety consensus statements as evidence to justify and drive higher standards locally.

And finally, keep records of your advocacy and implementation efforts. This not only protects your institution but also sets a precedent for others to follow.

Rizik reported serving as a consultant for ECLS, Inc.

Lois Anzelowitz Levine is a lifestyle and medical writer in Dallas.