Attendees in a SCAI session on cath lab safety and emotional well-being emphasized planning and exercise to stay healthy.
MONTREAL, Canada—Interventional cardiologists have long juggled the occupational risks of radiation and the pain that comes from wearing heavy lead clothing, but they often struggle with how to stay healthy and make changes to their working environment to keep themselves and their staff safe.
In an interactive session last week at the Society for Cardiovascular Angiography and Interventions (SCAI) 2026 meeting, panelists and audience members expressed frustration about not being heard by administration and often not knowing where to go or what to say to get changes made.
Occupational injury and illness routinely shorten careers in the field, as described in the documentary Scattered Denial, which featured prominent interventional cardiologists who now want to help the next generation be more vigilant than they themselves were early in their careers.
In her presentation here, Allison G. Dupont, MD (Northside Hospital Heart Institute, Lawrenceville, GA), described a recent experience with herniated discs that kept her out of the cath lab for 3 months. Although she has returned, and despite daily physical therapy, she’s still in pain every time she puts on her lead.
The injury forced Dupont to think about changes she could make to minimize her pain while also working through what she’ll do when other injuries occur.
“Because they will happen, and they’re not always due to the lead themselves, but the lead contributes to our pain. One issue is our awkward posture,” she said. The need to work at challenging angles leads to upper back and shoulder pain that is compounded by the weight imbalance of wearing lead and the compressive forces on the lumbar spine. According to Dupont, a 15-pound lead apron can place 200 to 300 pounds per square inch of pressure on the lumbar discs.
I encourage everyone here, even people who are very young, who’ve never had a single back issue in their life, to start these exercises. Allison G. Dupont
Dupont coauthored last year’s SCAI survey of interventional cardiologists and fellows in training, among others, showing that rates of orthopedic injury had not declined at all since a prior survey in 2014. With the occurrence of her herniated discs, she joined the 21% of her colleagues who reported taking a leave of absence due to an occupational injury.
One of her realizations, Dupont said, was the importance of “training to wear lead” with targeted exercises. Among these are neck, chest, back, wrist, and lateral trunk stretches. Others include shoulder circles and targeted stretches for the hips, knees, heels, calves, and hamstrings. All of these exercises, with photo illustrations for how to do them, can be found in an open-access article published in JSCAI.
“I encourage everyone here, even people who are very young, who’ve never had a single back issue in their life, to start these exercises,” she said. “If there’s one thing I wish somebody would’ve taught me when I was a fellow it’s how important this is because now I’m suffering the consequences of not doing this before I got injured.”
Speaking with TCTMD, Dupont stressed the need for more discussion during interventional training around proactively preparing yourself physically and mentally for cath lab-related injury.
“If I had known what I needed to do to prevent this injury in the first place, I would have been doing that all along,” she said. “It’s not only radiation safety that we need to be aware of, but also strengthening the core. I thought I was very strong before I got injured. And it’s not just us who need to focus on this, it’s our staff in the lab, too. Unfortunately, I think what happens with many of us is when we’re young and just out of training we feel invincible, we feel healthy, and we don’t think anything is going to happen, until it does.”
Debating Comfort and Safety at Work
One potential solution discussed by Dupont and others is wearing two-piece leaded gear to take some of the weight off the shoulders and spine. Splitting it up into two pieces allows for some of the weight to sit on the shoulders and some at the hips, noted session co-moderator Holly Bauser, MD, PhD (Children’s Memorial Hermann Hospital, Houston, TX).
Dupont said while she hasn’t made any major changes to her lead yet, her injury and a malignancy in another interventional cardiologist at her institution has led to the decision by administrators to purchase one of the newer radiation-protection systems.
Adopting these lead-free systems can pose challenges because operators must justify the expense to administrators who question how the system helps patients or generates revenue. Interventional cardiologists who are currently healthy might also not push for more advanced radiation protection because they don’t want to slow procedure times down.
Be an advocate for ergonomic infrastructure. Sara M. Trucco
In her presentation, which included an overview of institutional strategies to improve safety and wellbeing, Sara M. Trucco, MD (UPMC Children’s Hospital of Pittsburgh, PA), asked how many people in the room had advanced radiation protection available to them. Only one raised their hand.
Trucco said in addition to formal radiation safety programs and real-time cumulative dose monitoring, little things can go a long way in helping cath lab staff be proactive about prevention. These include making a physical therapy program available and requiring mandatory safety education, not just for onboarding, but throughout the course of someone’s career in the lab.
“Be an advocate for ergonomic infrastructure, trying to get the right lead,” she added. “If someone loses a lot of weight, get them new lead. These are small things that can help.”
Trucco said different body types may require different lead to be comfortable, adding that ensuring the back is covered as much as possible is an important consideration for two-piece fits, “unless you are making a conscious effort not to turn.”
Bauser encouraged her colleagues in the room to think about their physical needs and comfort when they walk into the cath lab, and to make adjustments to be as comfortable and safe as possible. For her, the floor mat in front of the table, which is meant to add comfort when standing for a long time, can actually be hugely problematic. Bauser said she often finds herself standing half on and half off it for the majority of a case.
“I actually have gotten to a point where I remove the mat because it’s worse for me than having a mat in place,” she said. “Just think before you walk up to the table, because all these have cumulative risks going into them. One or two cases seems like not a big deal, but 10 years later we’re talking about back injury because your feet are [positioned awkwardly] on the mat.”
To TCTMD, Dupont said these discussions about awareness and implementation safety affect everyone working in the cath lab and recommended the 2026 tool kits that SCAI has compiled that can help inform decisions around local safety, policy changes, purchasing decisions, and other issues affecting daily practice.