The risk of exposure to scatter radiation in catheterization labs is most often associated with the staff positioned nearest the fluoroscopy or X-ray equipment, such as doctors, nurses, and technicians. However, recent research has shown that a largely overlooked group of cath lab workers are exposed to significantly more radiation than anyone else: trainees.
Medical students, residents, and fellows suffer the highest levels of scatter radiation exposure as they learn hands-on procedures and techniques they will use later as interventionalists. Studies have shown that trainees can receive up to 34% more scatter radiation than other team members during training. But why do students face more radiation exposure in the first place? The answer is simple. Cath-lab trainees stand very close to the operator for long, often complex cases, making them similarly vulnerable to scattering X-rays.
Cath lab trainees scrub in with the lead cardiologist and shadow that doctor during lengthy procedures, staying close to the operator and increasing their risk of scatter exposure. This is why it’s more important than ever to develop and adopt advanced technologies that can protect everyone in the lab, especially the most vulnerable, as they prepare for their careers.
Fortunately, a combination of factors is emerging that could improve the future for cath lab trainees. Awareness of trainees’ increased exposure is growing, while the field also faces significant workforce shortages. This has encouraged some students to raise their voices, resulting in a demand for advanced, lab-wide radiation safety solutions to better protect trainees.
ALARA & Awareness
For decades, since its enactment in 1991 as part of the U.S. Nuclear Regulatory Commission law, radiation safety has adhered to ALARA, “As Low As Reasonably Achievable.” In practice, this has meant heavy aprons and as many fixed shields as the room can accommodate. The downstream effects of these measures have resulted in cluttered catheterization labs and an orthopedic toll on staff and operators, without fully addressing the exposure risk for the most vulnerable learners. However, these static barriers can also create problems for cath lab workflow, ease of use, and freedom of movement during procedures.
With new scatter radiation blocking technologies, including whole-room protection (such as the Radiaction Dynamic Smart Shield) and lighter, more ergonomic protective clothing (such as the EtherealShield from our partner Burlington Medical), exposures can be substantially reduced for everyone in the cath lab while actually lightening the physical load. A growing number of stakeholders, especially interventional trainees, believe that in 2025 these features are both reasonable and cost-effective, considering the high price of inaction.
Interventional Cardiologists: Too Few and Worried
The breadth of concern is evident in a 2023 member survey by the Society for Cardiovascular Angiography & Interventions (SCAI). In it, 60% of the 296 respondents reported musculoskeletal injuries, and 6% reported a history of cancer — rates that are much higher than for the general population. The survey concluded that meaningful progress will require innovative technologies and lighter, better-designed protective apparel, and some institutions are already heeding that call. Another strong research recommendation is to mandate thorough and continuing radiation protection education starting in medical school. That approach not only protects individual clinicians but also cultivates informed advocates who can drive system-level change.
Saving costs and the health of cath lab workers are powerful motivators, but there’s a concern that goes well beyond that. As a country, the field faces shortages of interventional cardiologists. The reasons behind that are likely related to the long hours and high demands of the specialty, but concerns about scattered radiation also factor into some of the shortfall in interventional cardiology trainees. Trainees are increasingly gravitating towards programs and jobs that invest in advanced radiation protection and smart room design. Institutions that cling to outdated shielding risk losing talent.
Going forward, change is both necessary and underway regarding cath lab radiation safety, especially for our precious and most-exposed interventional trainees. As awareness spreads of the dangers of musculoskeletal and radiation injuries due to long hours of exposure and heavy gear, pressure is building to improve working and learning conditions. And as institutions compete for a dwindling number of new interventional cardiologists, they can no longer ignore demands for advanced technology and effective scatter radiation protection for staff and students. The technology is here, and more is coming, and after decades with little progress, the trend towards safer interventional labs and healthier workers now seems unstoppable.