May 1, 2025 – Analyses from the (Ergonomics in the Cardiac Catheterization Laboratory (ERGO-CATH) study show the traditional approach using a lead apron causes 43% of interventional cardiologists to experience discomfort, building on existing consensus of the significant occupational health risks that exist in the catheterization (cath) lab. The data were presented today at the Society for Cardiovascular Angiography & Interventions (SCAI) 2025 Scientific Sessions in Washington, D.C.
The cath lab is a designated hospital room for minimally invasive tests that visualize the heart and blood vessels using X-rays or catheters. Due to the radiation from X-ray use, laboratory personnel often wear lead aprons to protect themselves. However, traditional lead aprons are heavy: a 2023 SCAI survey found more than 60% of cath lab worker respondents reported experiencing orthopedic injuries from hours of lead apron use. Though it is well-understood that cath lab personnel experience higher rates of occupational injuries, ranging from radiation-associated complications (cataracts and cancers) to orthopedic issues (spine, hips, knees, or ankles), there is a lack of research quantifying the ergonomic strain on catheterization operators.
"It is essential to prevent cath lab associated injury and pain, and identifying which subsets of interventional cardiologists and staff who are at highest risk is essential. SCAI is focused on optimizing occupational safety, recognizing that mitigating these risks is critical to sustaining our profession and delivering the highest quality care." said SCAI President James B. Hermiller, MD, MSCAI. " We are committed to advancing innovative research that fosters a safer work environment and advocating for the newest technologies and strategies that shield those in the field from radiation exposure and protect them from lifelong, career-impacting orthopedic pain and injury."
Traditional Lead Approach Causes 43% of Interventional Cardiologists to Experience Discomfort
The ERGO-CATH analysis was a single-center, prospective study designed to evaluate ergonomic strain on individuals in the cardiac cath laboratory. Researchers placed electromyography electrodes and inertial monitoring units (IMUs) on the cervical, thoracic, torso-pelvic, and lumbar regions of the spine. The primary endpoint was the percentage of time spent in high-risk positions (+/- 20°) such as cervical axial rotation (moving the head and neck to the right or left), cervical flexion (the bending of the head towards the chest), and thoracic flexion (bending forward and rounding of the upper back).
Radiation was measured using a real-time dose monitoring system and divided by the use of a lead-less apron (Rampart device) versus a traditional lead apron approach. There were 20 operators (38% female, mean age of 40.7 years) including attendings, fellows, and physician assistants/associates (PAs). The comprehensive cohort time spent in a high-risk position was: 35.8% (cervical axial rotation), 15.6% (cervical flexion), and 5.7% (thoracic flexion). When comparing traditional lead and the lead-less approach, researchers noted a similar percentage of time spent in high-risk positions: cervical axial rotation (lead: 35.9% versus lead-less 35.6%), and thoracic flexion (lead: 6.4% versus lead-less: 4.4%). Using a modified Cornell discomfort scale, data revealed 43% discomfort when wearing lead versus 35% when wearing lead-less, while the average measured radiation for the traditional lead was 0.73 mrem versus 0.14 mrem for the lead-less approach.
“Since these individuals work with radiation often, protection is needed. However, traditional lead radiation protection brought significant levels of pain,” said Ajar Kochar, MD, MHS; Interventional Cardiology Fellowship Program Director at Brigham and Women's Hospital in Boston, Mass. and lead author of the study. “Our study makes it clear that other solutions are needed, like the novel lead-less approach, to help reduce the pressure on the spine and overall pain.”
Fellow and PA Cath Lab Operators Frequently Exposed to High-Risk Cervical Positions for Extensive Durations
An additional sub-analysis of the ERGO-CATH study sought to examine catheterization laboratory operator ergonomic strain by stratifying for sex-based differences and laboratory roles. These findings suggest cath lab operators in fellow and PA positions are exposed to high-risk ergonomics more often and at longer durations than those in attending positions, leading to a strong likelihood of occupationally caused pain.
This study comprised 21 operators (38% female, mean age of 40.7 years) of different roles, including attendings, fellows, and PAs. Female operators were more likely to be fellows or PAs (47%). When separated by sex, average times in high-risk positions were determined as cervical flexion: 17.6% (female) versus 14.1% (male), cervical axial rotation: 33.4% (female) versus 37.6% (male), and thoracic flexion: 6.5% (female) versus 5.1% (male). When graded by operator role, mean times in high-risk positions were cervical flexion: attending (11.9%) versus non-attending (16.6%), cervical axial rotation: attending (32.2%) versus non-attending (36.7%), and thoracic flexion: attending 4.4% versus non-attending 6.1%.
“Our study underscores the urgent need to adopt novel solutions to radiation protection, many of these novel innovations allow cath lab operators to work without any lead or with ultra-light lead which will help reduce the axial load and presumptively decrease musculoskeletal discomfort,” said Greta Campbell, BA, Clinical Research Coordinator at Brigham and Women's Hospital in Boston, Mass., and lead author of the study.
Future clinical studies will be necessary to determine if significant differences exist between the ergonomic injuries of male and female operators.
This abstract is published in the SCAI Abstract Supplement, which appears in SCAI’s official journal, JSCAI. You can access it here: https://doi.org/10.1016/j.jscai.2025.102671.
May 05, 2025 
