Protect the Team: Reducing Radiation Exposure and Spine Injury in the Cath Lab
© 2026 HMP Global. All Rights Reserved.
Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Cath Lab Digest or HMP Global, their employees, and affiliates.
James B. Hermiller, MD, MSCAI, FACC
Director of the Interventional Cardiology Fellowship and the Structural Heart Program, St. Vincent Ascension Heart Center, Indianapolis, Indiana; Past President 2024-2025: Society of Cardiac Angiography & Intervention (SCAI)
At CRT 2026 in Washington, DC, James B. Hermiller, MD, MSCAI, FACC (Director of Interventional Cardiology, St. Vincent Medical Group) delivered the Nurses and Technologists session “Cath Lab Occupational Safety: Are We Making Any Headway?”, arguing that yes, cath lab safety is improving, but only if teams treat radiation and orthopedic injury as daily, solvable problems.
He noted that over the last 3 to 4 years, the Society for Cardiovascular Angiography and Interventions (SCAI) has made cath lab occupational safety a focused mission and underscored that it is now a major professional priority. It is one of the most relevant topics for cath lab professionals because it affects careers, quality of life, and long-term health.
The Risks We Worry About Most: Cancer and Radiation Exposure
Dr. Hermiller acknowledged what many cath lab staff fear: malignancy from working around fluoroscopy. He shared personal examples from his own practice, including having partners diagnosed with leukemia, and reminded the audience that left-sided brain tumors have been documented in interventional operators. He also cited cataracts as a real occupational risk, estimating that they occur in about 5% of cath lab workers.
One point often underestimated is left-sided breast cancer risk, which may relate to inadequate or poorly fitting lead and the fact that the left side of the chest can be exposed during cases. His recommendation for staff was to ensure well-fitting lead and consider a sleeve to improve coverage, especially for the left breast and shoulder region. Dr. Hermiller also cited a recent SCAI survey finding an overall cancer prevalence of around 6% among cath lab workers.1
The Injuries That End Careers: Spine and Orthopedic Damage
What Dr. Hermiller believes is even more likely to remove people from the lab is orthopedic injury. He gave examples of severe outcomes in colleagues (including catastrophic spine injury) and described his own experience after a prolonged structural case: following a long MitraClip procedure, he felt a disc rupture, developed severe weakness within days, required emergent surgery, and has dealt with ongoing pain. His point was not to sensationalize, but to underline that this is a common and work-related problem in cath lab environments.
After asking the room who has back pain and noting a significant number of hands raised, he stated that survey data show about 70% of cath lab workers report back pain, with most saying it is related to the job. Dr. Hermiller pushed back on the idea that “it’s just aging,” arguing that the rates are higher in cath lab staff than in the general population. He compared general population rates (lumbar disease ~10%, cervical disease ~3%, hip disease ~19%) with cath lab workers and stated the risk is roughly 3x higher for lumbar disease and 10x higher for cervical/neck disease, while hip and knee issues were not different, a useful control to show that spine risk is tied to cath lab work habits and lead load.
ALARA Basics Are Still the Foundation
Dr. Hermiller briefly revisited classic radiation reduction principles (ALARA: “as low as reasonably achievable”), emphasizing that basics still matter. His guidance focused on time, distance, and geometry: reduce fluoroscopy time, avoid unnecessary pedal time, optimize table and image intensifier positioning, and limit steep angles that drive up dose. “Get off the fluoro pedal. It’s not a nightlight,” he said.
The Shift to “ALARA+”: Advanced Shielding and Less (Or No) Lead
The field is moving beyond “ALARA alone” into what Dr. Hermiller called “ALARA+”, meaning ALARA plus advanced radiation protection devices/shielding (ARPDs). The goal is not just incremental dose reduction, but is to get to minimal or even zero measurable radiation exposure for both staff and physicians, and to reduce dependence on heavy lead that contributes to orthopedic injury.
This is a team issue, not a physician-only issue. The objective is to protect everyone in the room and to make it realistic to wear very light lead or, where allowed and safe, to work without lead behind effective shielding systems. Dr. Hermiller has worked without lead for about a year and a half, and described a major improvement in how he feels physically.
What the Newer Shielding Systems Can Do
Several advanced radiation protection systems are being used in labs including EggNest [Egg Medical], Rampart, and Protego. Dr. Hermiller noted adoption has increased compared with 3 years ago. He shared performance examples: with Protego, 70% of cases resulted in zero recorded radiation for operators and staff behind the barrier, even when the operator was not wearing lead. He also described large dose reductions, including 20–30 fold reductions cited for Rampart.
Dr. Hermiller offered a simple way to think about the impact: when you reduce dose significantly, you can do far more cases before reaching accepted annual exposure limits. Using the common 5 rem annual limit as a reference point means you could do about 14,400 cases with Rampart without lead, compared with about 800 cases with lead. He also highlighted that these shielding technologies are evolving. One example is the Radiaction System, which positions barriers up on the image intensifier and down by the generator and can reduce scatter by about 90–95%. AI is also helping reduce radiation output at the source; Dr. Hermiller cited Omega Medical, an AI assisted imaging system, that achieves an 85% consistent reduction in radiation coming out of the tube, translating into up to a 90% reduction in radiation reaching staff. Newer approaches that include novel AI-enabled dose reduction at the source may further reduce radiation output.
He warned that if a lab is moving toward lighter lead or lead-free workflows, teams need real-time monitoring so they know their protection is working. Many states such as Michigan and Indiana now allow lead-free work, but it is a state-by-state regulatory pathway. SCAI is developing a toolkit to help programs navigate requirements.
Beyond Radiation: Posture, Neck Load, and Daily Habits
Dr. Hermiller broadened “occupational safety” beyond radiation to focus on posture in the cath lab. Staff and physicians are leaning forward for long stretches. Small posture changes can create big forces on the cervical spine. The head weighs about 12 pounds with good posture, but when you bend forward, that load can rise to 40–50 pounds, putting major stress on the neck. He cited ergonomic monitoring from the ERGO-CATH study showing that in a typical case, the neck is in a high-risk position about 34% of the time.2
Dr. Hermiller’s message for nurses, technologists, and physicians was to treat posture as a skill, not an afterthought. If the room setup and shielding allow you to stand more upright and farther from scatter, you reduce both radiation dose and musculoskeletal strain.
Self-Care to Reduce Pain
Dr. Hermiller closed with advice: maintain conditioning, stretch, and build routines that reduce pain over time. He warned against jumping into high-risk training such as CrossFit that can worsen back injuries and instead encouraged stretching programs that have shown improvements in pain among cath lab workers.
Bottom line for cath lab teams: Dr. Hermiller’s message was optimistic that progress is real, and the path forward is practical. Commit to ALARA fundamentals, add advanced shielding (ALARA+), reduce heavy-lead dependence when safely possible, monitor exposure in real time, and treat posture and conditioning as essential parts of the job.
References
1. Abudayyeh I, Dupont AG, Hermiller JB, et al. Occupational health hazards in the cardiac catheterization laboratory: results of the 2023 SCAI survey. J Soc Cardiovasc Angiogr Interv. 2025 Mar 4; 4(4): 102493. doi:10.1016/j.jscai.2024.102493
2. Kochar A, Gattani R, Campbell G, et al. Orthopedic risks to cardiac catheterization operators wearing traditional lead protection versus using novel lead-less solutions: insights from the prospective ERGO-CATH study. J Soc Cardiovasc Angiogr Interv. 2025 May; 4(5): suppl, 102977. doi:10.1016/j.jscai.2025.102977
