Radiation safety in the cath lab: Experts say the time to act is now

Clinical takeaway: Clinicians and health systems should begin planning for routine use of enhanced radiation protection devices (ERPDs) and real-time dosimetry, as experts now consider these technologies part of the contemporary standard for achieving “as low as reasonably achievable” (ALARA) radiation exposure.

Radiation exposure remains a significant occupational hazard for clinicians and staff working in fluoroscopy-guided environments, contributing to cancer, cataracts, reproductive concerns, and musculoskeletal injuries from prolonged use of heavy lead apparel. Experts argue that newer technologies have fundamentally changed what is achievable under radiation-safety standards and should no longer be considered optional.

In a joint expert consensus statement from SCAI, ASE, HRS, SIR, and SVS, endorsed by the American College of Cardiology, authors call for “mandatory and urgent” implementation of enhanced radiation protection technologies in fluoroscopic laboratories. The document argues that occupational radiation hazards remain underrecognized despite links to malignancy, cataracts, reproductive concerns, and chronic orthopedic injuries caused by years of wearing heavy protective aprons.

The authors contend that recent advances in radiation protection have reshaped the ALARA principle because current technologies can dramatically lower exposure for physicians, nurses, technologists, anesthesiologists, and echocardiographers. Multiple commercially available ERPDs, including advanced shielding systems, barrier platforms, and wearable support systems, have demonstrated radiation reductions ranging from approximately 90% to more than 99% compared with conventional approaches.

“Adoption of enhanced radiation protection technologies and safety practices is no longer optional; it is now mandatory,” the writing group states, framing occupational radiation safety as both a moral imperative and a regulatory responsibility.

Key recommendations include immediate implementation of available ERPDs, routine use of real-time dosimetry to monitor exposure and guide safer practices, stronger institutional oversight through radiation safety programs, and standardization of radiation protection regulations across states. The statement also urges manufacturers to integrate advanced radiation-safety features into new fluoroscopy systems and recommends development of national certification, reporting, and occupational dose-registry programs.

The authors conclude that because commercially available ERPDs can reduce operator and staff exposure by up to 99%, these technologies now define the contemporary standard for occupational radiation protection and should be adopted without delay to protect healthcare workers from preventable harm.

Source: Rizik DG, et al. (2026 July 14) JACC Cardiovasc Interv. SCAI/ASE/HRS/SIR/SVS Expert Consensus Statement on Enhanced Radiation Protection: Time for Mandatory and Urgent Action