Interventional cardiologists around the world have expressed concern over the findings of an Israeli colleague’s medical journal report suggesting aggressive brain cancer – especially on the left side of the head – may be an occupational hazard from their exposure to ionizing radiation. Prof. Ariel Roguin, chief of interventional cardiology at Haifa’s Rambam Medical Center, and colleagues presented new data on four interventional cardiologists – all of them diagnosed with incurable brain tumors of the left side – which due to the equipment they use are exposed to the radiation source during procedures.Roguin, who also teaches at the Technion’s Rappaport Faculty of Medicine, told The Jerusalem Post on Tuesday that he wrote the article to increase awareness of the possible risks of the profession. Other cardiologists and radiologists, who are not interventional, are able to sit in another room and do their work, but those who have to function at the patient’s side in catheterization rooms must get close to the ionizing radiation, he said.The interventional specialist, he said, already wears heavy lead protectors that cover the chest and thyroid glands below the neck to minimize exposure and reduce the risk of cancer.But the head and hands are not covered, and Roguin said he knows of no one in the specialty who wears a lead helmet. They also have a special card that monitors accumulated radiation exposure over time.While hospitals usually check them, private clinics and hospitals may be less careful, and the interventional specialists may ignore warnings of overexposure because it would prevent them from working, Roguin said.The Rambam specialist, who said he performs 600 such procedures a year, wrote the article in the latest issue of the peer-reviewed journal EuroIntervention, along with the Carmel Medical Center’s Dr. Jacob Goldstein and Dr. Olivier Bar of a cardiology interventional imaging clinic in France.
They summarized the medical literature that included another two interventional cardiologists and three interventional radiologists with brain cancer for a total of nine documented cases since 1997. The data was obtained from medical records and interviews with family members or colleagues of the victims.
All the physicians who had the type of aggressive brain cancer called gliomas were men who had been in the profession for decades, the article said. There were no women, as there have been very few senior female doctors in the profession, and only now have some joined the ranks.
DNA damage is considered to be the main initiating event by which radiation damage to cells results in slow development of this type of cancer, said the Rambam cardiologist. Those performing the procedures are likely to receive high radiation exposure in spite of protection.
Roguin said that at any medical conference involving the specialty “I see every doctor over 35 carrying his bags on trollies. They can’t pick them up because they all suffer from orthopedic problems caused by the weight of the lead protectors worn while standing six or eight hours daily.”
The doctors suffer from aches and pains in the neck, back, hips, knees, and ankles that range in severity.
“Fortunately, the orthopedic problems usually can be relieved by rest and other conservative methods. The more potentially serious danger in interventional cardiology is radiation.”
Solid evidence-based medicine in this field, conceded Roguin, is lacking. The reported cases might be a matter of chance without any relationship to occupational hazards, he said, “yet it is reasonable to assume that ionizing radiation does not improve health!” The medical journal’s editor, Prof. Patrick Serryus, wrote in an accompanying editorial: “In this paper it’s us – the physicians that become the patients… It is a sobering but important aspect of what we do that we keep ourselves as informed – and healthy – as possible in order to continue to offer the best for our patients and ourselves in over not only this new year, but for many more years in the future as well.”
Goldstein added: “Hospital workers exposed to low doses of ionizing radiation had a higher frequency of early chromosomal changes than did controls. Indeed, chromosomal aberrations in peripheral blood lymphocytes have been used for many years to monitor human populations exposed to potential carcinogens.”
Co-author Bar from Clinique Saint-Gatien in Tours, France noted: “As these malignancies are rare, the question whether exposure to ionizing radiation indeed increases the risk is not easy to answer. Most of the calculations are based on atomicbomb calculations, and there is a great debate if this can be also [applied] to cancer probability.
The risk estimates at the population level can be highly inaccurate at the individual level.
“When measuring occupational doses from fluoroscopy- guided interventional procedures, several studies calculated an increased cancer risk caused by professional radiation exposure in modern invasive cardiology practice.”
Since the Israel Medical Association and the government signed the new doctors’ contract, interventional cardiologists and radiologists were recognized as facing occupational hazards and given more time off, but the agreement does not note whether the hazards included standing and wearing heavy protective equipment of radiation exposure, Roguin said.
Rambam Medical Center director-general Prof. Rafael Beyar, who is also a leading interventional cardiologist who continues to perform procedures, noted that three years ago, one of his colleagues, Dr. Ehud Grenadier died of a brain tumor on the left side of his head. He underwent surgery, but it didn’t help.