Washington, D.C. – May 1, 2025 – A groundbreaking ergonomic study presented at the 2025 Society for Cardiovascular Angiography & Interventions (SCAI) Scientific Sessions has shed light on the significant physical toll experienced by interventional cardiologists due to traditional radiation protection methods employed in catheterization laboratories. The Ergonomics in the Cardiac Catheterization Laboratory (ERGO-CATH) study reveals that nearly half of cardiologists endure discomfort from prolonged use of heavy lead aprons, reinforcing longstanding concerns regarding occupational health risks in these critical medical environments.
Cardiac catheterization laboratories, or cath labs, are specialized hospital rooms equipped for minimally invasive imaging and intervention of the heart and blood vessels. These procedures rely heavily on X-ray technology, which poses radiation risks to the healthcare providers present. To mitigate radiation exposure, personnel traditionally don lead aprons that offer substantial shielding. However, while effective against radiation, these aprons impart a severe mechanical burden, contributing to a myriad of musculoskeletal complications. Prior surveys from SCAI indicated over 60% of cath lab workers suffer from orthopedic issues related to these protective garments, highlighting a pressing need for innovation in occupational safety.
Despite widespread recognition of radiation-related hazards such as cataracts and malignancies, the precise ergonomic strains placed upon cath lab operators have remained under-explored. ERGO-CATH sought to fill this gap by quantifying the physical stresses endured by these medical professionals during procedures. Integrating electromyography sensors and inertial measurement units (IMUs), the study meticulously tracked spinal positions in multiple regions—including the cervical, thoracic, torso-pelvic, and lumbar areas—evaluating how often and how long operators maintained potentially harmful postures.
Central to the investigation was the comparison between traditional lead apron use and an emerging lead-less alternative, the Rampart device, which promises significant reductions in weight without compromising radiation protection. Data collected on 20 cath lab operators, representing attending physicians, fellows, and physician assistants, revealed striking insights. The cohort spent upwards of a third of their procedural time with their neck rotated laterally by 20 degrees or more, while flexion of the cervical and thoracic spine was also notable. These sustained postural deviations are well-known antecedents to musculoskeletal pain and injury.
Quantitatively, the discomfort reported by operators was substantially higher when using traditional lead protection, with 43% indicating notable pain levels. Conversely, the lead-less device group reported a lower discomfort incidence at 35%. Radiation exposure measurements further favored the lead-less solution, recording average doses of 0.14 mrem compared to 0.73 mrem for the conventional apron, demonstrating that weight reduction need not be achieved at the expense of safety. These findings underscore the potential of new technologies to revolutionize both operator comfort and radiation shielding efficacy simultaneously.
Dr. Ajar Kochar, Interventional Cardiology Fellowship Program Director at Brigham and Women’s Hospital and principal investigator of the ERGO-CATH study, emphasized the dual imperative of radiation protection and ergonomic health. “Our data highlight that while shielded by lead aprons, cardiologists are subjected to mechanical stresses contributing to career-impacting pain. This calls for urgent adoption of novel solutions, such as light or lead-free protective options, to alleviate these occupational hazards.”
The investigation also delved into ergonomic disparities across clinical roles and sex. Fellows and physician assistants showed higher exposure to high-risk cervical flexion and axial rotation positions compared to attending physicians. Female operators, who comprised a significant portion of the cohort, displayed marginally greater durations in certain risky postures, pointing to potential sex-based anatomical or behavioral factors influencing musculoskeletal risk. These nuances deserve further investigation to tailor preventative strategies effectively.
Greta Campbell, Clinical Research Coordinator and co-lead author at Brigham and Women’s Hospital, highlighted these implications: “The differentiation in postural strain by role and sex within the cath lab environment signifies the complexity of the ergonomic challenges faced. Transitioning to innovative, ultralight protective apparel may mitigate these stresses, reducing the axial load on the spine which is a principal contributor to discomfort and injury.”
The ERGO-CATH research employed sophisticated biomechanical monitoring technologies—a combination of electromyography and inertial measurement—to capture real-time muscular activity and spinal positioning. This level of precise quantification allows for an objective assessment of occupational ergonomic stress, a methodological advancement over previous subjective surveys. Such rigour sets a new standard for occupational health studies in interventional cardiology.
Looking forward, the authors advocate for expansive, multicenter clinical trials to validate these initial findings and to discern the long-term impact of ergonomic interventions on operator health outcomes. The potential influence of sex and professional role on susceptibility to musculoskeletal injury warrants carefully designed subgroup analyses to develop personalized protective strategies that preserve both operator well-being and procedural performance.
The presentations detailing the ERGO-CATH findings are scheduled at the upcoming SCAI Scientific Sessions, providing a platform for cardiology and occupational health communities to engage in dialogue around these critical challenges. By spotlighting the intersection between radiation safety and ergonomic health, this study propels forward the agenda of improving the professional lives of those who deliver cutting-edge cardiovascular care.
In sum, the ERGO-CATH study brings to light an often-overlooked dimension of occupational risk in the catheterization laboratory—ergonomic strain linked to radiation protection practices. As technology progresses, the shift towards light and lead-free protective solutions holds promise not only to safeguard against radiation but also to substantially reduce musculoskeletal injury risk, thereby enhancing the sustainability of interventional cardiology careers.
Subject of Research:
Orthopedic and ergonomic risks associated with traditional lead aprons versus novel lead-less radiation protection solutions in cardiac catheterization laboratory operators.
Article Title:
Orthopedic Risks to Cardiac Catheterization Operators Wearing Traditional Lead Protection Versus Using Novel Lead-Less Solutions: Insights from the Prospective ERGO-CATH Study
News Publication Date:
May 1, 2025
Web References:
https://doi.org/10.1016/j.jscai.2025.102671
https://scai.org/scai-2025-scientific-sessions
Image Credits:
Society for Cardiovascular Angiography & Interventions (SCAI)
Keywords:
Catheterization, occupational health, ergonomics, radiation protection, lead aprons, orthopedic injury, interventional cardiology, musculoskeletal strain, cardiovascular interventions
