Key Points:

• Medical professionals are raising the alarm about prolonged radiation exposure in their careers 

• Three proposals would help smaller hospitals install enhanced radiation protection systems

• Opponents say medical technology mandates are costly and short lived 

Modern heart procedures have advanced the cardiology field by miles, allowing doctors to treat heart problems with minimally invasive procedures often performed in a cardiac lab. 

Yet what has not advanced, and what experts say is overlooked danger, is the fact that the imaging technology needed to perform these many life-saving procedures often comes with a hidden, personal cost for medical personnel — radiation exposure.

Dr. David Rizik, who has worked as an interventional cardiologist for 40 years, said doctors, nurses and technicians who do multiple procedures a day are exposed to significant levels of radiation over the course of their careers. They spend thousands of hours in the lab, each minute increasing exposure and heightening the risk of future cancers and orthopedic problems.

As an interventional cardiologist, Rizik uses fluoroscopy, which is a real-time X-ray, to place a stent, open a blocked artery, repair a heart valve and close holes in the heart, among other procedures. 

“We do some remarkable, remarkable things. It also comes with a potential price and we don’t think about that price when we have a sick patient in front of us,” Rizik said. “That’s our professional obsession, if you will, is making the patient in front of you better.”

While lead aprons and protective eyewear do offer some protection from ionizing radiation, there are two main issues that leave medical professionals with lingering problems. 

The first is that the apron only covers the body from the clavicle to the knees, but leaves the head, face, neck and arms exposed, he said. 

The second is weight. A lead protective apron can weigh well over 10 pounds, and, over time, that puts a lot of pressure on the body, Rizik said. In a recent study of interventional cardiologists, 66% of the people in his profession said that they have irreversible orthopedic and spine issues.

“I’ve always said the lead apron is less than a pure cure. It incompletely covers us but creates a whole new disease process amongst people in my profession, and that new disease process is spine and neurologic disability,” Rizik said. 

In 2013, a study published in the American Journal of Cardiology showed a causal relationship between the radiation that medical professionals are exposed to and brain tumors, Rizik said. The authors studied 31 interventionists in Rizik’s profession who developed left-sided brain tumors. Other doctors reported that leg hair did not grow on their left legs because the left side of the body is more exposed to radiation.

In a documentary titled “Scattered Denial,” Rizik and other doctors explain the risk they take every time they’re in the lab, which can be multiple times a day and for hours at a time. The longer the exposure, the higher the risk. 

“We’ve done nothing substantive over the same 40 years to make the cath lab a safer place,” he said.

Multiple studies are also showing that many women have grown wary of joining a profession that could expose them to radiation and its subsequent risks to pregnancy and childbearing, he said. 

Another issue is a decrease in the number of people entering the field overall. While there is usually a waiting list for training programs, this year was the first time the training programs were not full, Rizik said. 

But not all hope is lost. Rizik said several hospitals in Phoenix have already implemented systems to reduce scatter radiation exposure drastically — and they have backup.

Sen. Carine Werner, R-Scottsdale, has introduced three bills to address the concerns, with all three headed to the House of Representatives for consideration. 

The three measures’ shared goal is protecting health care professionals who work in the catheterization labs, particularly interventional cardiologists like Rizik, who have been shown in several studies to have a significantly higher rate of left-sided brain cancers, Werner said in an interview. 

Senate Bill 1118 would appropriate $3 million from the state general fund to the Department of Health Services to establish a grant program to assist rural hospitals with the costs of installing radiation protection systems in cardiac catheterization rooms. The bill passed the Senate on a third read with a vote of 28-0-2. 

Senate Bill 1120 would require hospitals to ensure at least half of the procedure rooms are equipped with a radiation protection system. That bill, if passed, takes effect July 1, 2027. It passed the Senate on a third read with a vote of 25-5.

Senate Bill 1121 would prohibit hospitals from requiring health professionals to wear lead aprons during those procedures if the procedure room is equipped with a radiation protection system and the health professional is working in the radiation protection system’s designated safety zone. This bill passed the Senate on a third read with a vote of 27-2, with one not voting.

If the dangers are addressed, proponents say the move could bolster Arizona’s already extensive medical network with more recruitment and retention.

“We try to be an innovation leader and health care professionals would want to come here because we have safe practices, and we are on the forefront of new technologies that are going to not only help patients, but also help our health care professionals be safe and be able to do their job even better,” Werner said. 

However, not everyone is on board yet. Helena Whitney, Senior Vice President of Policy and Advocacy for the Arizona Hospital and Health Care Association, said they oppose it because it’s a mandate. 

“It’s a little difficult to have the Legislature codify a specific device into statute before there’s really concrete evidence from the national professional societies and endorsement from the FDA that said device is actually superior and will provide more safety to our clinical workforce,” she said. 

Whitney acknowledged it could “potentially provide better protection but not for everybody in the room,” but said there is not enough scientific evidence to indicate that this particular device is superior to the protections already used today. 

“If this was something that everyone was like, ‘Oh my gosh, this is going to make everybody exponentially safer,’ we would have already seen adoption of this,” she said.

Rather, she said they would prefer incentive-based adoption, or perhaps pilot projects that are grant supported, and cited the need for ongoing data collection to assure validity of the devices. She also said they need to demonstrate that it is, in fact, superior to the current protocols endorsed by the Occupational Safety and Health Administration (OSHA). Whitney said they want to continue those conversations but haven’t been able to reach an agreement. 

“Always, from a hospital perspective, we do not prefer mandates particularly on things like this that are so technologically driven and at the pace that technology changes today, mandating specific equipment and statute is pretty dangerous,” she said. 

Another concern is the cost, which would be more than just the purchase price, Whitney said. The devices would require maintenance and upkeep, plus training staff on how to use them. 

For Rizik and others in his profession, better protection would go far toward protecting themselves and the future of their career field.

“Is my life not worth it? Is my life not worth it to them?” he said.