Two Central Nervous System Tumors in One Catheter Lab: Time to Rethink Radiation Protection

Very little research has been done on the possible effects that repeated, frequent, and low-dose ionizing radiation exposure has on the long-term health of interventional cardiologists.

Following the diagnosis in the same year of two central nervous system tumors in two operators working in the same catheter laboratory, we sought to compare the effect that introducing a new catheter laboratory would have on total patient dose.

We analyzed the radiation dose over an 18-year period for 9002 patients (2006-2025) as two cohorts, 2006-2019 (Lab 1, 5677 patients) and 2019-2025 (Lab 2, 3326 patients).

We found that there was an upward trend in total exposure dose for Lab 1 before it was decommissioned (R² 0.78). This reduces by 30.2% with the introduction of the new Lab 2. Although there was a significant reduction in fluoro dose between the two labs (Lab 1 mean 1221.5 cGy/cm², Lab 2 1079.8 cGy/cm², difference 11.6%, p < 0.025), most of the reduction in total dose was attributable to a significant fall in acquisition dose (Lab 1 mean 887.7 cGy/cm², Lab 2 379.2 cGy/cm², difference 57.3%, p < 0.025).

Accepting the hypothesis that there is a linear no-threshold dose response relationship between low-dose ionizing radiation exposure and cancer risk in operators, we can understand factors that may have contributed to unnecessary excess exposure and how this could be prevented. X-ray patient doses increased steadily over time, without a change in procedure time. The significant reduction in dose following the introduction of new equipment strongly suggests that ionizing radiation doses should be closely monitored, with plans in place to routinely replace equipment on an 8 to 10-year cycle.