Protecting clinicians from DNA damage during X-ray-guided cardiovascular procedures

Healthcare staff could be at risk of DNA damage from X-rays during certain types of heart and circulatory procedures – so it’s especially important they wear the right protective kit.

11 January 2018, by Siobhan Chan

Medic looking at screens showing X-rays of the heart during a procedure

Radiation shielding is important for clinicians involved in X-ray-guided techniques

Surgeons’ and radiologists’ DNA could be altered during certain routine procedures, according to a study led by BHF Senior Clinical Research Fellow Bijan Modarai1.

The study explored operators’ exposure to radiation during fluoroscopy, an imaging technique that uses real-time X-ray images to guide procedures, such as endovascular aortic repair.

By studying biomarker levels in the blood of clinicians before and after they took part in these procedures, researchers found that clinicians experienced DNA damage from the X-rays unless they wore lead shields on their lower legs.

The highest doses of radiation arrive at leg level because the radiation source is under the operating table, so the scatter hits legs directly.

The findings of this study on vascular surgeons and interventional radiologists are also relevant to interventional cardiologists, orthopaedic surgeons, nurses and anaesthetists, says Mr Modarai – a Reader and Consultant Vascular Surgeon at King’s College London and Guy's and St Thomas' NHS Foundation Trust.

Radiation risk

Anecdotal evidence suggests occupational radiation exposure may increase the risk of cancers and cataracts, but a causal link has yet to be established.

Clinicians aren’t always aware of the risks to their health, and often forego wearing protective equipment. Lead gowns, aprons and protective goggles should be worn as standard, but fewer surgeons tend to wear leg shields.

“Leg shielding can be cumbersome to wear but staff don’t always realise how useful it is,” said Mr Modarai.

Protective kit

 Imaging showing endovascular thoracoabdominal aortic aneurysm repair
Above: procedures that are guided by X-ray include endovascular aortic aneurysm repair

To find out what equipment is frequently worn during these types of procedures, Mr Modarai’s team also surveyed 464 radiation-exposed staff. To their surprise, 58% did not wear lead leg protection and 21% did not wear goggles during these procedures – results they presented at the annual general meeting of the Vascular Society of Great Britain and Ireland in November 2017.

But preventing radiation exposure isn’t just down to awareness – some staff might not have access to protective leg shields. Mr Modarai hopes that his finding will help to make the case for providing this equipment as standard.

Limiting exposure

Mr Modarai carries out these procedures weekly, but he thinks the issue could be even more relevant for interventional cardiologists that perform fluoroscopically guided interventions like coronary angioplasty and ablation more frequently.

There are other steps staff can take to limit exposure, such as distancing themselves from the source of radiation and changing equipment settings to suit the stage of the procedure when high-quality images aren’t needed.



1 El-Sayed T, Patel AS, Cho JS, Kelly JA, Ludwinski FE, Saha P, Lyons OT, Smith A, Modarai B. Radiation Induced DNA Damage in Operators Performing Endovascular Aortic Repair. Circulation online 2017 doi:10.1161/circulationaha.117.029550