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Cardiologists’ Bodies Fight Effects Of X-Rays

August 24, 2011
Written by: , Filed in: Cardiac Imaging, Interventional Radiology
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We talk a lot these days about the risks of radiation exposure to patients, but what about the risks to doctors? Specifically, to interventional cardiologists who perform heart surgery using X-ray-guided catheters?

A new study, published online Tuesday in the European Heart Journal, suggests that the level of ionizing radiation to which they’re exposed does cause cell damage, but that the cardiologists’ bodies deploy protective countermeasures.

The study says interventional cardiologists are the health professionals who are most exposed to ionizing radiation, experiencing doses two to three times higher than those of radiologists—up to the equivalent of 250 chest X-rays each year. The Italian researchers compared 10 interventional cardiologists to 10 health workers who were not exposed to radiation.

The scientists found increases among the cardiologists in the levels of two chemicals: glutathione, an antioxidant that protects against cell damage from oxygen-carrying molecules called reactive oxygen species (ROS), and hydrogen peroxide, which indicates the amount of oxidative stress caused by the ROS. In the radiologists’ immune systems, lymphocyte cells showed increased susceptibility to apoptosis—programmed cell death.

Here’s what the researchers think was happening: the radiation was creating potentially harmful changes at the cellular level. The body reacted by nearly doubling the amount of protective glutathione and increasing the susceptibility of white blood cells to a natural dying-off process—possibly the body’s way of eliminating damaged and therefore potentially cancerous cells.

The study’s first author was Gian Luigi Russo, PhD, a senior research scientist at the Italian National Research Council’s Institute of Food Sciences in Avellino. “Our findings clearly emphasize for the first time,” he said, “that exposure to a level of radiation which is considered ‘safe’ by regulatory standards for interventional cardiologists can induce a profound biochemical and cellular adaptation whereby increases in the levels of reactive oxygen species in these workers are balanced by an improvement in antioxidant defenses.”

However, he added:

It remains unclear whether these changes are adaptive, beneficial modifications or the harbinger of clinically relevant adverse changes, since increased DNA damage, oxidative stress, and apoptotic activity have been involved in the development of a variety of diseases.

Dr. Russo was quoted in a European Society of Cardiology news release via EurekAlert!

An accompanying editorial in the Heart Journal says … well, frankly, not much. “A wider use of potentially dangerous technologies should, however, come with a more thorough awareness of their implications,” etc.

Here’s what it should have said: Everyone on the team, especially the interventional cardiologist her- or himself, needs to try to minimize incidental radiation exposure. And equipment manufacturers and operating-room designers need to do everything they can to corral stray X-rays. We keep discovering new ways that our remarkable bodies can ward off and repair damage, but we can’t count on those defenses to be perfect.

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Related seminar: Interventional Radiology Review

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