The problem has already started to become noticeable in the U.S. "We know from some of the older cardiologists who complain they don't see the fluoroscopy screen as well as they used to." And, he adds, "anecdotally, we know that sometimes what they do is turn up the gain (for better visualization), which increases the X-ray dose, so you're accelerating the problem," Kleiman says.
He likened the danger to that of "the canary in the mine," with a potential risk for higher rates of head and neck cancer or even brain tumors, because of occupational exposure to radiation in healthcare procedures.
"If they're not protecting their head, there's potential risk to anything above the neck," Kleiman warns.
Representatives of the American College of Cardiology could not be reached for comment, but Paul Teirstein, MD, a well-known interventionalist at Scripps Clinic in La Jolla, CA, says he's skeptical that the problem is that pronounced in the U.S. "Everybody I work with wears them (leaded goggles). And it's surprising to me that that would not be a routinely used by the doctors in the study. If they weren't fully protected, I would have to ask, 'Why weren't they?' "
Kleiman responded that he knows many U.S. cardiologists who tell him it just isn't a routine practice, something he hopes later research will prove.
These studies were done in other countries because International Atomic Energy Agency was interested in funding them there, but he also has a study underway to look for lens changes in interventionalists and others who work in catheterization labs at Columbia.
The studies were performed during cardiology conferences with comprehensive dilated slit-lamp exams. Each participant also was given a questionnaire asking about their workload exposures, use of protective screens and personal protective devices, and where they worked in the catheterization labs.
Lifestyle and medical factors also were explored, including sunlight exposure, steroid use and cigarette smoking, which could have a small bearing on the result as well.