Compared with radiologic technologists who have never performed fluoroscopically guided interventional procedures, those who have done so seem to be at markedly increased risk of dying from brain cancer and at moderately increased risk of developing melanoma and breast cancer.
While the authors behind the study note that these results may owe to risk factors unrelated to radiation exposure, or to plain chance, their work has already spurred at least one serious call for changing the culture within which these procedures are performed.
Reporting their findings in the May edition of the American Journal of Roentgenology, Preetha Rajaraman, PhD, of the National Cancer Institute and colleagues describe their work analyzing a nationwide prospective cohort of 90,957 technologists.
The analysis showed a pronounced risk for brain cancer mortality among the techs who had performed fluoroscopically guided interventional procedures versus those who hadn’t (hazard ratio, 2.55).
The numbers also uncovered modest elevations in incidence of melanoma (HR, 1.30) and breast cancer (HR, 1.16).
No significant increase was observed in mortality from all cancers combined among the techs who had worked with the fluoroscopically guided technology, and there were no elevated risks of various other cancers, including those of the thyroid, prostate, lung and colon.
Among the research limitations the authors acknowledge, a lack of detailed information on radiation doses is the most prominent.
In their discussion, Rajaraman and co-authors write that the “immense patient benefit provided by fluoroscopically guided interventional procedures is indisputable, and the risks that we observed for brain cancer, breast cancer, and melanoma among technologists who reported working with these procedures should be interpreted in that context.”
They note the possibility of coincidence over cause-and-effect, adding that their findings need to be confirmed in future studies that, ideally, incorporate detailed dose information across a broad range of cancers and other radiation-associated diseases—and among not only techs but also physicians.
“Patients should continue to undergo medically necessary imaging examinations,” the team concludes, “but healthcare providers should keep radiation exposure as low as reasonably achievable without compromising essential diagnostic information.”
Commenting on the study in the same issue of AJR, three authors led by Gabriel Bartal, MD, director of medical imaging and interventional radiology at Meir Medical Center in Israel, issue an urgent call for a “radiation protection culture” to emerge among those working with fluoroscopically guided interventional procedures.
“The findings reported by Rajaraman et al. and their analysis clearly indicate a need to implement a radiation protection culture based on a teamwork concept by involving technologists, physicians, and medical physicists,” Bartal and co-authors write.
“One of the problems in interventional fluoroscopy rooms is that the passive protective tools, such as protective screens, are available for the primary operator and not for additional staff,” they add. “Procedure planning should integrate dose management measures because the goal of planning is efficient and optimal use of radiation, not to instill an irrational fear or allow negligence.”