Medical Societies Call for ‘ALARA+’ Safety Standard to Reduce Radiation and Injury Risks in Fluoroscopy Labs

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Medical Societies Call for ‘ALARA+’ Safety Standard to Reduce Radiation and Injury Risks in Fluoroscopy Labs

Teams delivering minimally invasive care face radiation exposure and orthopedic injuries that could be reduced through new policies and modern technology.

WASHINGTON—Nine leading medical societies are calling for updated safety standards in fluoroscopy laboratories, often called “cath labs,” where clinicians performing minimally invasive procedures face radiation exposure and orthopedic injuries from heavy protective equipment. A report published simultaneously today in JSCAI, Heart Rhythm, JVIR, and JVS–Vascular Insights details the health, financial, and workforce impacts of fluoroscopy-guided settings and proposes an enhanced safety framework: ALARA+, or “As Low and As Light as Reasonably Achievable.”

The report addresses the dual occupational hazards linked to fluoroscopic procedures—radiation exposure and orthopedic strain from traditional protective equipment—and aims to ensure that safety is built into the environment, equipment, and standard of care.

“How we think about radiation safety has been historically guided by the ALARA principle, or ‘as low as reasonably achievable.’ But that approach has proven to be not safe enough for healthcare staff working in fluoroscopic labs,” said Robert F. Riley, MD, MS, FSCAI, chair of the 2025 Summit on Radiation and Orthopedic Risks in Fluoroscopic Labs. “Traditional ALARA principles focused on incomplete methods of minimizing radiation exposure. Additionally, they did not fully account for the orthopedic strain caused by wearing heavy lead protective equipment during long procedures. The new framework, ALARA+, calls for responsible protection strategies that are ‘as low and as light as reasonably achievable’ for the entire team.”

“ALARA+: Summit on Radiation and Orthopedic Risks in Fluoroscopic Laboratories” is endorsed by the Society for Cardiovascular Angiography and Interventions (SCAI), American College of Cardiology (ACC), Alliance for Cardiovascular Professionals (ACVP), American Society of Echocardiography (ASE), Heart Rhythm Society (HRS), Society of Interventional Radiology (SIR), Society of NeuroInterventional Surgery (SNIS), Society of Vascular and Interventional Neurology (SVIN), and the Society for Vascular Surgery (SVS).

Fluoroscopy is widely used to perform minimally invasive procedures that treat conditions such as heart attack, stroke, and vascular disease. Using real-time X-ray imaging, clinicians guide catheters and other devices through blood vessels to diagnose and treat disease without open surgery. While these procedures improve patient outcomes and shorten recovery times, they carry long-term occupational risks for the teams performing them, as they receive thousands of low but repeated radiation doses over the course of their career. To reduce exposure, clinicians often wear heavy lead or lead-equivalent protective garments that can weigh 15 to 20 pounds. However, the strain of wearing them during long procedures contributes to chronic neck, back, and joint injuries.

“These occupational harms affect every member of the procedural team and the healthcare system as a whole, carrying major financial and human costs,” said Summit Co-Chair Arnold H. Seto, MD, MPA, FSCAI. “Across fluoroscopy laboratories, clinicians and staff face both cumulative radiation exposure and the physical burden of heavy protective equipment. Over time, that means years of strain from protective gear and nonergonomic lab setups. The consequences are real. People develop chronic pain, require surgery, and some are left with severe spinal conditions that limit or even end their procedural careers. Maintaining a skilled workforce in these labs, which is already in limited supply, is essential to ensuring patients have access to these lifesaving procedures. As demand for minimally invasive procedures continues to grow, protecting and retaining experienced teams will be critical to preserving and expanding access to care.”

A 2023 Occupational Health Hazards Survey from SCAI found that roughly two-thirds of interventional cardiologists report musculoskeletal pain related to working in the catheterization laboratory or wearing radiation protection equipment. These risks affect the entire procedural team, including physicians, nurses, technologists, and imaging specialists. Trainees may accumulate higher exposure near the radiation source while developing procedural skills. Concerns about radiation exposure during pregnancy and the physical burden of protective lead are often cited as discouraging many women from entering or remaining in fluoroscopy-based specialties.

To address these risks, the multi-society summit report calls for several actions to improve safety in fluoroscopy laboratories, including:

• Accelerating the adoption of modern radiation protection technologies, such as suspended, freestanding, or table-mounted shielding systems that reduce exposure without requiring clinicians to wear heavy protective garments
• Expanding real-time radiation monitoring to enable clinicians to receive immediate feedback and reduce exposure during procedures.
• Strengthening education and training in radiation safety and exposure reduction for physicians, trainees, nurses, and technologists.
• Continuing technological innovation to protect all catheterization lab clinicians.
• Supporting regulatory and accreditation standards that promote safer fluoroscopy laboratory environments.

“ASE supports the ALARA+ concept as a matter of urgency, to mitigate the radiation and ergonomic risks faced by interventionalists, echocardiographers, anesthesiologists, nurses, sonographers and all staff in the fluoroscopic laboratory. ASE’s recent membership study showed that 13% of organizations did not have adequate safety measures in place. Radiation exposure and orthopedic injuries are workplace liabilities which urgently need strengthened oversight and attention from institutions during fluoroscopically-guided procedures. We hope by participating in this document this helps ring the alarm and leads to better safety standards in the future.” stated ASE President David H. Wiener, MD, FASE.

DOI: https://doi.org/10.1016/j.jscai.2025.104166

Article URL:  https://www.jscai.org/article/S2772-9303(25)01612-6/fulltext

About Society for Cardiovascular Angiography & Interventions (SCAI)

The Society for Cardiovascular Angiography & Interventions, established in 1978, stands as the primary nonprofit medical society dedicated to representing invasive and interventional cardiology. SCAI’s mission is to guide the global interventional cardiovascular community by fostering education, advocacy, research, and upholding standards for quality patient care. For more than 40 years, SCAI has exemplified professional excellence and innovation worldwide, cultivating a reputable community of over 5,000 members committed to advancing medical science and providing life-saving care for individuals, both adults and children, affected by cardiovascular disease.  For more information, visit SCAI.ORG.

About American Society of Echocardiography
The American Society of Echocardiography (ASE) is the Society for Cardiovascular Ultrasound Professionals™. ASE is the largest global organization for cardiovascular ultrasound imaging serving physicians, sonographers, nurses, veterinarians, and scientists and as such is the leader and advocate, setting practice standards and guidelines for the field. The Society is committed to advancing cardiovascular ultrasound to improve lives. For more information, visit the ASE website ASEcho.org or social media pages on Facebook, X, LinkedIn, Instagram and Bluesky.