Honor Health Foundation.

[music playing] There has never been a better time to be a patient with cardiovascular disease.

The technological advancements and innovations save lives and improve quality of life.

Wow, fantastic.

I miss that loud heart murmur you used to have.

I did too.

Radiation exposure is cumulative.

In other words, if you catch a cold, you get the cold, and it goes away.

Radiation exposure doesn't go away.

[music playing] The radiation exposure that I had 30 years ago is still with me.

The radiation exposure that I had 30 minutes ago is added on to the exposure I had three decades ago.

And so, the consequences of radiation exposure, whether it's to the bone marrow, to the brain, orthopedic injury, it's additive.

It adds up over time.

Forgotten in all of this is the welfare of the nurses and the patient care techs who perform these procedures with the physicians all day long.

[music playing] One of my earliest mentors was a great physician named Dr.

Ted Diethrich.

Ted Diethrich, there are a handful of people in the world who changed cardiovascular medicine, changed patient care to the degree that Dr.

Diethrich did.

I'd had this carotid endarterectomy six years before, and I thought that it must be related to a recurrence of the carotid.

So, when the person picked me up and said, “Where do you want to go?

Do you want to go back to the heart hospital where they took the carotid out?” I said, “No, I want to go to Barrow's because I think I'm having a stroke.” And it turned out I didn't have a stroke, I had a brain tumor.

As innovative as Dr.

Diethrich was, as immortal as Dr.

Diethrich seemed to be, he probably died of the consequences of radiation exposure.

We have not put adequate emphasis on staff safety, physician safety, nursing safety in the cardiac catheterization laboratory.

That has been largely ignored.

[music playing] [music playing] [music playing] [cricket sound] I've been performing cath lab procedures for over 30 years, and I've done well in excess of 10,000 procedures.

It's not a CTO, it's certainly a CSL.

So, you definitely have nodular calcium there.

Family is the center of my life.

We have four children, four daughters, who are the love of my life and the reason that I get up in the morning and go to work.

[people talking] They are absolutely everything to me.

like the only man I know who's literally surrounded by all women.

[people talking] [clapping] When you think about family, this all of a sudden becomes very real and there's a certain vulnerability that you begin to feel.

The adverse consequences of radiation exposure really consumes me.

And over the last four decades, and especially over the last 10 years, there have been equipment enhancements to promote safety and reduce injury to college athletes.

Very necessary.

However, in the most advanced field of medical science, over that same time frame, little has changed in the lab to reduce occupational health hazards.

By the time you've been in the cardiac catheterization laboratory for 20 years, and many of us have, you've had the equivalent of 20,000 chest X-rays to the head and neck.

That's an amazing - that's an astounding number.

The burning topic for me and for the rest of my career is going to be everything we know about radiation and orthopedic injury.

Ruptured disc, completely paralyzed right leg, emergent surgery.

Muscle wasting, foot drop.

We spend a long time in training.

I mean, nobody could believe when I started working, all my friends.

I finally got a job when I was 34 years old.

I was in training nonstop till I was 34 years old, right?

So, that is just a lot of training, a lot of work.

It takes a lot of time to get there.

Now you want to maximize your career potential, especially now when physicians are sort of in short supply.

What radiation allows us to do is to see inside the patient, and it can guide how we move our catheters and how we implant certain devices.

Every time we step in here to save a life, we are exposing ourselves to potential harmful effects of ionizer radiation.

None of us do this because we want to make money or we want to be famous.

We all do this because it's a passion.

You know our lives are completely disrupted.

You get a call at 2:00 in the morning for somebody that's sick that you have to go in and take care of.

So, that's kind of the responsibility.

I kind of look at it as you're a lifeguard and you're watching, and then there's somebody who's dying in front of you in the ocean.

I mean, you're going to say, “Okay.

Well, maybe I might risk myself to go get that person,” but you really don't.

You think about, I have to go save that life.

It's remarkable when you're young and just starting out in the cath lab doing these procedures.

You're more focused on getting good at the procedures and getting good at treating patients.

And so, you really don't think about radiation exposure.

I think it definitely took a backseat during my development and my training.

I think that we did not pay attention to it, if you're excited about the procedures.

You're excited about all these different changes that were occurring in the field of interventional cardiology.

And I think radiation was not a priority.

I know myself didn't wear a badge for more time than I probably should admit.

Unfortunately in training, you're not really taught about radiation other than when you're studying for nuclear medicine boards and imaging.

But in the cath lab, you really aren't taught about where the radiation comes from, what are levels that you can typically get.

You wear your badge and it's being monitored.

But many times, honestly, we take our badges off because we know we're going to exceed those limits.

And our passion is to be in the cath lab.

The amount of radiation that we're exposed to is tough, and there's very good data showing that we are the occupation that is exposed to the highest amount of radiation.

The only other occupation that even comes close is people who work in nuclear power plants.

And even those are exposed to less than half of what we get.

The issue with radiation is it's a cumulative effect, but it's also you don't know how your body's going to respond to the radiation.

Like many of my patients who smoke, some of them smoke all their lives and their arteries look pristine.

And other patients smoke for 10 years and their arteries are all chewed up and look like 80-year-olds.

So, you just don't know how your body's going to respond to a certain risk or a certain toxin.

Any radiation is bad.

And the effects of that radiation could come out later in life, even way past the time that you stopped exposing your body to radiation.

[bells ringing] Radiation is a form of energy, a high energy form of light.

When you start to get up into the higher energy levels, such as X-rays and gamma rays, this is when the light radiation becomes more penetrating.

When it becomes more penetrating, it has the ability to overcome the energy holding electrons in their orbits around the atom.

Once you have an ionization effect, that can lead to a chemical change.

And if that chemical change occurs in a critical component, such as your DNA, this then can lead to biological effects.

We are all exposed to background radiation on a daily basis.

Cosmic rays, ultraviolet.

In most cases, if you have just low doses of radiation, the body will repair any damage to, say, the DNA.

When you get into higher doses, or when you get into more chronic exposure, meaning on a daily basis, the effects become cumulative.

What that means is that the body's mechanism for repairing the cell may not work.

This could lead to mutations and also to cell death.

[vehicle sounds] How did we get here?

How did we get to the cardiac catheterization laboratory?

So, what exactly is this mural?

This is a mural of things in medicine.

Things that - The history of medicine?

History of medicine, exactly.

Who's number 28?

So, that's Rontgen, the discoverer of X-ray.

The history of radiology begins with Conrad Rontgen, who discovered and developed the use of ionizing radiation to see through a hand, and first demonstrated that you could see bone through skin.

This is an image of the first radiograph taken in 1895.

As soon as he developed that film, it became an international phenomenon.

In the beginning, many people using radiation, because you couldn't see it, feel it, or really be aware of it, didn't fully understand its potentially damaging effects.

Not too long after that in 1904, a gentleman by the name of Clarence Dally died from an overexposure of X-rays.

He was working in Thomas Edison's laboratory in the development of a fluoroscope X-ray machine.

He went through multiple amputations before he finally died from the overexposure in 1904.

Edison's reaction was not good.

Edison basically said, “I will have absolutely nothing to do with X-rays or radiation from here on.” There were times here in the United States when children or adults could go into a shoe store, put on a pair of shoes, and look at your feet with fluoroscopy, using ionizing radiation for that purpose.

That's kind of the cavalier attitude that people had.

The dangers of X-rays really weren't appreciated at first.

There was radiation quackery that ranged from electrical discharge to drinking radium-laced water.

However, deaths and injuries began to gain attention, such as renowned physicist Marie Curie, who discovered the elements, polonium and radium and coined the term radioactivity.

She died in 1934 due to aplastic anemia, a condition that was attributed to her fieldwork during War I, where she developed mobile radiography units.

The unprotected exposure probably cost her life.

The dangers of radiation were now beginning to be noticed.

Radiology as a specialty really kind of developed through the early 1900s and into the middle of that century, as specialists began studying more and more the use of this radiation to be able to see inside the body.

The concept of using X-ray and fluoroscopy to actually deliver treatment really began to develop, initially with angioplasty and the work of Charles Dotter.

This was in the ‘60s, and then rapidly begin to accelerate.

You could see inside the body, you could get a catheter someplace, and now could we deliver treatment.

You know historically it was cut and sew, cut and sew, cut and sew.

Everything was done with a knife and sutures.

And now things are done through minimally invasive cath lab openings, either in the leg or the wrist with fluoroscopy.

It's been a story of great innovation and great perseverance, and there have been some phenomenal, phenomenal innovators in the science of catheter technology.

So, here we are where interventional cardiology at Emory started.

This is the sixth floor of Emory University Hospital.

When we recruited Andreas Gruentzig in 1980, it was a fantastic five years.

Unfortunately, we lost him in 1985 and started the Andreas Gruentzig Cardiovascular Center of Emory, which continues today.

Charles Dotter was a radiologist in Portland, Oregon, and he's the man who first did angioplasty, but not in the coronaries.

He did it in the leg.

And he didn't do it with balloons.

He did it with catheters.

That technique, by the way, which was not adopted in the United States very much, was used in Europe.

Andreas Gruentzig began doing the Dotter technique and said to himself, “Well, this is never going to work for anything, but these big leg arteries.

If I'm going to try to develop any kind of similar technique for the heart, I've got to have a catheter that goes in small, but when it gets to the target, has to get big.” So, what's the solution?

And the solution that occurred to him was the balloon.

So, we had some early evidence that, okay, we're really doing something.

So, opening the artery is relieving the stenosis, but over time, that artery can close back down through several mechanisms, and we call that re-stenosis.

And when it becomes severe enough, then it can once again restrict the blood flow in the artery.

And that was the real shortcoming of angioplasty in those early days.

The balloon catheter is quite a good answer.

But the more we depart, as I said, to more diffuse disease, the more we have to change our direction to additional catheter systems.

Julio!

[laughs] Good to see you, my friend.

I'm Julio Palmaz.

I'm a retired interventional radiologist.

I've been essentially recognized as being the originator of the balloon expandable stent.

I invented a device out of necessity by seeing or identifying the limitations that the state-of-the-art had at the time.

Turns out this idea of putting a permanent implant inside an artery and opening it up so it kept it open, it was a pretty intriguing idea to me.

A lot of people thought this would never happen.

I started tinkering at home with the wires, pliers, and soldering material, and so forth.

So, we finally had a product all together here that we could use.

And so, we sponsored some clinical trials.

And lo and behold, these two studies discovered that there was a remarkable advantage of stenting versus just balloon angioplasty of about 30%, 35%.

Since the arrival of the balloon and the stent, fluoroscopic-guided therapies have exploded.

More complex cases that treat previously untreatable diseases, longer procedural times, and that's not to mention other specialties outside of cardiovascular care.

The point is, fluoroscopic-guided therapies have absolutely exploded over the last 40-plus years.

Going from a few simple diagnostic studies to the millions of procedures that we see today.

So, how do we stay safe?

Well, there are some basics.

The three principles of radiation protection are time, distance, and shielding.

The more time you're exposed to X-rays, the more radiation dose you get.

Distance, as you increase your distance between yourself and the source of radiation scatter, you can decrease your exposure by that distance squared.

The third principle is shielding.

The primary thing we want to do is to protect the interventional cardiologist by putting lead material between them and where the beam intersects the patient.

Hits the table and the patient, and it gets dispersed in 360 degrees.

So, everyone around is going to get scattered radiation.

This scatter radiation is the occupational risk of radiation to the interventional cardiologist and their team.

Most of those early years were spent developing this by radiologists.

These are people who are specially trained in the use of X-ray, the hazards of X-ray, the need for protection.

But as image-guided therapy grew, we had multiple disciplines using X-ray.

And many of these disciplines did not have fundamental training as part of their training course.

We started to see a host of other types of problems develop.

The patient is Mr.

Bernard Schuler.

We shall return to the specifics of his case after Dr.

Edward B. Diethrich, medical director of the Arizona Heart Institute, introduces the surgical team at the St.

Joseph's Hospital and Medical Center Operating Theater.

Dr.

Diethrich?

Good evening to the studio.

Can you hear us all right?

Loud and clear.

Good.

We'd like to take you on a quick tour of the operating room before we start the actual operation.

I want you to - Probably after we talk about people like Michael DeBakey and Denton Cooley, the name Ted Diethrich comes up as far as American cardiac surgeons and innovative surgeons.

Ted was a pioneer in the surgical space and in the advancement of endovascular therapy.

At a time when many surgeons felt that surgery was the gold standard and less invasive technology where technologies were inferior and should not be deployed in patients, Ted adopted the exact opposite position and tried to bring that benefit to his patients.

Dr.

Diethrich was fearless.

He took patient care head-on.

My motive was make it safer and make it simpler.

And that is the real thing that led into the endovascular field where you didn't have to make an incision, you didn't have blood loss.

Patients could be discharged sometimes the same day.

Dr.

Diethrich was a cardiothoracic surgeon who was one of the first to actually get into the peripheral world of doing this.

It was left to interventional radiologists and cardiologists.

Ted had an enormous interest in getting in cutting-edge technologies, and he was always at the forefront in the development of many things.

My whole mindset was we're going to do the procedure.

We're going to show people how to do the procedure.

We're going to be the leaders in the world in the development of devices for the technologies that we want to conquer.

And the last thing I was thinking about was how much radiation am I exposing my body to?

I think I felt this radiation cannot hurt me.

It can't hurt me.

I felt indestructible.

Obviously I didn't know what I was talking about, did I?

[laughs] I think that his death brought a real awareness to all of those in the endovascular world about the risk of radiation exposure working in the cath lab.

It is a controversial subject, not totally proven that people that have been exposed to X-rays will or had developed brain cancer.

It could have been coincidental or it could have been a causative factor, but it's not totally accepted that that is the case.

It's just not known yet.

We're doing the experiment right now.

I feel pretty confident that my patients are safe, right?

We don't worry about patient radiation.

Even the fellow or woman that's come back for multiple procedures, that risk to them is zero.

[people shouting] My name is Juan Bernal.

I'm an interventional cardiologist in Birmingham, Alabama.

I wanted to share with you guys the story of Dr.

Arciniegas, so Dr.

Arci as we all knew him.

The story is very close to my heart.

Not only because he was a colleague, a partner, but also a mentor and most importantly a father-in-law.

You know, he was one of the greatest human beings that I've met.

As a family member, he truly showed us the value of unconditional love and support.

As a physician, he really was a role model for all of us as what true doctorship should be.

He trained as a general cardiologist and subsequently as an electrophysiologist.

He was in the lab a lot of the time.

He always had in the back of his mind a concern with his exposure to radiation.

He was diagnosed in January 2020 with a brain tumor and he passed away in April 2021.

I think many from the professional level, they lost a friend.

From the personal aspect, I think seeing his [music playing] Sorry.

[music playing] grandchildren grow up.

[music playing] The cancer problem is real and that one in 25 of us will probably die of a radiation-induced cancer and that's a very high statistic.

I want you to think about why the left side of the body is so important.

The way we stand and position ourselves in the cath lab, the radiation source is from our left.

It's scary as heck when you think about the fact that when you look at interventional cardiologists with brain cancer, that over 8 out of 10 of those brain cancers are going to be on the left side.

So, we stand right next to the radiation emitter and what I've noticed is that on my left leg here, I don't have any hair at all here.

It's just on the one side It's just on the one side because that's where I'm standing and the radiation's up to it.

So, it's really strange.

My name is John Thomas Eagan, Jr.

I'm trained as an interventional cardiologist.

I've been practicing since 1993.

So, my history of radiation exposure and my illness started around 2004.

I'd spent most of my career working at least five days every day in the cath lab, 10 to 15, sometimes 20 procedures a day.

And in the early 2000s, around 2003-2004, I began to develop multiple skin cancers, mostly on the left side of my body.

In my left lower leg, my left forearm, my left hand, my left shoulder, my left cheek, my left temporal area, and my left neck.

At the time, it was felt that these cancers were related to previous sun exposure.

So, I continued full-time work as an interventional cardiologist, spending five days in the lab, 10 to 20 procedures a day.

Over the next year or two, I began to experience more cancers on a monthly basis and then it began a weekly basis.

And then ultimately, around 2008 and 2009, I was going to the dermatologist almost every day because a new lesion was breaking out on the left side of my body.

At that time in 2009, it was determined by my doctors that I should step out of the cath lab, get no further radiation exposure.

It was recommended at the time that my illness could be radiation-related.

I ultimately published my history in the Journal of Interventional Cardiology at the time, and it showed in that article that about 90% to 92% of all my skin cancers were on the left side of my body.

When I went back into the cath lab, I tried to utilize as much protection as possible, but sometimes it wasn't practical to use complete protection trying to take care of very sick, acutely ill cardiac patients.

In around 2015, 2016, after two-and-a-half years back in the cath lab, I developed a recurrence of multiple skin cancers all on the left side of my body.

My left forearm, my left hand, the left side of my face, cheek, left shoulder, and left shin.

Went back to my doctors at UAB, and they immediately recommended that I remove myself from any radiation exposure.

That it had become cumulative and the effect were permanent, and that any more radiation exposure could be life-threatening.

All of us have had personal experiences of mentors or colleagues that have been diagnosed with cancer at a young age, and we always keep wondering, was that really the effect of radiation?

Or is it just some sporadic bad luck that has happened?

But everything points to the logic, conclusion, that the more a physician is exposed, that that is the end effect.

Well, I get very emotional.

This is what I wanted to do, so when I had to step away, it became very difficult.

I had to seek help from a psychiatrist.

I didn't know if I could ever practice again.

I worked very little.

But fortunately, I was able to get better and was able to come back as a non-invasive cardiologist, and that's what I do today.

I would like to say we know everything there is about radiation exposure and the effects on human tissue.

But I don't believe we know nearly enough.

[people talking] As physicians and scientists, we are really data-driven.

We look at large trials to determine how we make decisions for our patients, but when it comes to radiation exposure in the occupational sense, really limited in the data that we're relying on.

These are observations and extrapolations from Hiroshima, and that kind of data might not be as solid as we need to really understand what the true risk is to physicians and operators who are exposed to radiation on a daily basis.

I did a survey, a national survey, with the American College of Cardiology asking almost 600 fellows in training why they were interested in going to interventional cardiology and what were the reasons that they might not want to.

We found that men were much more likely to be interested in the field, but not for the reasons you would expect.

Women were much more concerned about radiation exposure, particularly during childbearing years.

[music playing] Well, I think that when my colleagues are pregnant, then it becomes a huge issue because we don't really know what is safe and how much is safe.

The most at-risk person when it comes to radiation are young females.

So, yeah, that definitely makes me think of, am I going to struggle to get pregnant because of what I've done for a career?

Cancer runs in my family pretty prevalently, so did I just increase my risk of getting cancer?

You know, Who knows?

[people talking] My name is Aimee Armstrong and I'm a congenital interventionalist, which means that I treat congenital heart disease, which are heart diseases that children are born with.

I got very little radiation training in my fellowship.

In fact, I barely even remember receiving any.

And I remember that the physicians who taught me didn't like to use the lead shields because they got in the way.

So, the lead that most people wear is two-piece lead.

We have a lead skirt that wraps around, and then we have a vest that either opens in the front or opens in the back.

And you can have a gap in the armpit area where X-ray could be getting through to your breast.

I was diagnosed with breast cancer in 2021, and this was a big shock because I don't have it in my family.

I don't have any genetic predisposition.

And it was in my left breast, which is the breast that is closest to the radiation when I work.

And because I'd had a very recent normal mammogram and ultrasound, I did not think I was going to make it for more than a year.

I was really worried about my family, how my family was going to go through all the important things in life without their mom or the wife.

And I also was sad for myself that I was going to be missing so many things in their life.

And I feel kind of selfish that that's what I thought, but I was feeling sorry for myself that I was going to miss out on so many fun things.

[people talking] You know part of the reason for wanting to avoid radiation is there's bad things that can happen from radiation.

And one of them, and how it applies to what I do, is that they can factor in the development of some tumors.

It's hard to pick it out before it happens.

Is that going to happen to me directly?

And so, that's why we just try to avoid any exposure to it because it's so hard to predict which of these things might be affected in me.

I don't want any of it.

Not a whole lot of people have put this together, have made the contact between extensive radiation and tissue damage.

I don't have the proof of the brain tumor.

It's a hunch.

I'll bet I'm right.

[laughs] I'll bet I'm right.

There's another type of exposure that we face after being in the cath lab.

And it's not just the radiation exposure, but it's wearing these lead aprons.

Remember, the lead aprons are about 30 pounds.

When you think about doing thousands of procedures over many, many years, that lead apron starts to take a toll from an orthopedic standpoint, knee injury, hip injury, back injury.

[music playing] My name is Bob Foster.

I'm an interventional cardiologist from Birmingham, Alabama.

I've been an interventional cardiologist about 30 years.

I've probably done 12,000 to 15,000 procedures.

Even early on in my practice, doing very long cases, I felt the orthopedic strain of wearing lead apron.

I was very active doing, running long distances, doing triathlons.

That was my passion.

And then, after about 15 years of doing these procedures, I ruptured my first disc.

And the orthopedic surgeon told me at that time that a lot of it was because of the lead apron that I was wearing.

And just wearing that weight day in and day out is putting too much pressure on my spine.

Well, the idea with wearing lead is it's just extra stress being put on the back of the spine.

And so, with cardiologists in particular, they have to wear those protective clothing.

It's like being a fireman.

They have to wear 80 pounds of gear to go into a burning house.

Well, sometimes it gets to where you can't do that physically.

I recovered from that pretty quick.

And probably within just a few months, I went back into the lab and just with the passion of taking care of patients, I went back full speed.

And what I was doing prior to the injury, thinking, “Okay, the injury has happened.” And now, I'll maybe reduce my running distances or alter some other portion of my life, but I was not going to alter what I did every day because I just loved it.

And at that point, was really reaching the peak of my career.

With any injury, even though the body can heal it, it probably means that you're a little more likely to have that injury again in the future.

So, it is something to have to keep in the back of your mind.

And it becomes a weighing the odds there, what's the risk benefit of this and the likelihood of things happening again.

So, then my disc ruptured again.

And the second time it ruptured was devastating for me.

My right leg was paralyzed.

I couldn't walk for over a month.

During that time, it was a time of reflection of this is going to end my career.

But it's also, more importantly, and I think more emotional for me, is I started thinking about my kids and my grandkids and what's life going to be like going forward when you have a paralyzed leg, and all the things that you think and dream that you want to do in the future.

And particularly actively as you're still working, but also after you retire, and all those dreams are shattered.

[people talking] There's been things that we no longer do that we both enjoyed.

For the provider of a family, it's tough when they have to step away from something that they love that they've trained for.

And it's not by choice to have to step away.

Yesterday was my last day in the OBL.

So, no more outpatient procedures.

Just went through all these last milestones after 30-something years.

I was able to recover and be able to walk again.

I stayed out of the cath lab completely for a year.

But the problem is the pain doesn't go away.

And they said the next one is going to be rods and plates and really big surgery.

And I don't want that.

I want to stay healthy.

So, the reason that I'm stepping away from full-time cardiology, because I have been - all of my life, my focus has been on patient care.

And rightly so.

That's why we signed the Hippocratic Oath.

But it's been at the expense of our own health.

And so, what I want to do is turn my focus from patient care to those who are taking care of those patients.

These people work in the lab, they're saving these lives every day, they're doing wonderful things.

But it takes people.

And these people have lives.

And these people have families.

And these people have a future and have dreams that when they get through with their occupation, when they say, “I have given my life and my passion to taking care of other people, but now that passion has damaged my body to the point that now I can't even enjoy the the fruits of the labor," then I think that's really a problem.

And I think we see that in our jobs.

The majority of interventional cardiologists end up with basically a damaged spine.

I've had one knee replacement.

I'm waiting for a hip.

I'm getting another knee done, and I got my lower back.

There were two studies that were done, one in 2004 and one in 2014 at one of our major meetings.

And one of the interesting things is that about 30% of those who had been practicing interventional cardiology for less than five years were already having back problems.

I mean, significant back problems where they had to reduce their caseload or take days off already because of back issues.

And that's in the people who have just started their practices.

If you go out 20 years and you've been practicing in the lab for 20 years, those statistics over 60% were already having limiting and disabling back issues.

Flipside of that too, if you look at people who don't do what we do, the risk of a disabling orthopedic issue is 3% to 4%.

And so, you're going from 3% to 4% if you don't do what we do to over 60%.

If you do, that's a big jump.

It's not a subtle figure.

So, it's time for change.

Let's find a solution.

The idea that we wear lead on top of us and we carry around our own shield, basically with your own spine, it's almost laughable.

You know what I mean?

I think that we protect the chest with lead and it's never really like entered people's minds before that, like, why are you standing here and getting your head radiated?

I think there's several systems available around the country that are geared towards mitigating the radiation exposure to the room.

We have a shielding system here that's really nice.

It's a one-inch thick lead shield that basically sits over the patient and blocks both the radiation from the source, as well as most of the scatter radiation.

So, we actually do not wear lead.

The newer technologies are really a barrier protection.

So, you place this barrier.

It's taking off the personal protection and giving you a community protection.

So, if you think of radiation as basically a source of light, then you want to stay in the shadow of that light.

This will fit as a half-moon over the patient.

Now, it's going to block the radiation coming from the image intensifier.

Now think about this.

Think about what a monumental movement forward, this is.

Less radiation exposure to the physicians and nurses, almost no radiation exposure and taking the lead apron off the physicians and nurses.

This has the potential to be game-changing technology.

We have done research in our cardiac catheterization laboratory on one such system.

And based on the data we have, you could perform 1000 procedures a year.

Now that's a lot of procedures.

You could perform 1000 procedures a year and still only be at 2% of the maximum allowable threshold for radiation exposure in a year.

Now you have to remember, this is to only protect the people who are sittaing on this corner, on this side of the patient.

If the person is in this side of the patient, they have no protection.

They still have to wear a lead.

All the cath labs, all of the operating rooms are built for how things were done in 1980s, 1990s, and early 2000s.

The need for building radiation, shielding radiation protection for people standing at the head of the bed is a concept that is still relatively new to vendors.

When you look at the reality of what we do every day, there's so many different specialties, right?

You can't stand in one place and do what you have to do.

You have to be one minute here, and then suddenly something happens four feet away from you, and you have to run to that place and then do whatever you have to do there.

And then, maybe you have to go outside and come back.

So, you're constantly moving.

So, there are some things that protect some boxes you put around a patient, but then you don't have access to the patient like you want to.

Maybe there's a role for a transition period, whether that's wearing the lead or going to a lighter lead.

I can see that.

But the ultimate goal is zero radiation.

There's a lot of things that we have to work on.

So, I think that's something that I think you're going to see a lot of improvement in the next couple of years.

As time goes on, once barrier technology is an accepted technology, then I think that that will go very fast.

But I think until then, we still have to work and plow that ground of acceptance that people are okay walking into a room without their lead apron on.

So, what about leaving X-ray behind altogether?

Could another modality actually replace X-ray?

Some of the new imaging modalities, these are important tools.

It's early on in their evolution, but this idea of doing fluoroless navigation is certainly here.

This is an example of a catheter and wire that's connected to - that has sensors called the IOPS, interoperative position system.

So, basically, without radiation, without fluoroscopy, we can navigate this catheter inside the patient.

So, what we did was try to develop a technique to do endovascular navigation using electromagnetic tracking.

In a lot of these procedures, there's almost always a high-quality scan, like a CAT scan, that's done beforehand.

You can use that to make a really high-quality 3D map to navigate through.

Essentially, we can see wires.

We can see catheters inside the patient anatomy without having to step on the radiation panel.

So, this, I think, is just the beginning, quite frankly.

Because with little more advances, I think better catheters, better wires, we are going to be able to do large parts of this procedure without radiation.

We feel that low-field MR scanning will change the field because we can use conventional equipment because the magnet isn't as strong.

It doesn't heat up the equipment as much.

We don't get these huge artifacts.

And if we can use the equipment that we already have with maybe some minor modifications, then industry is going to be more likely to partner with us.

So, this allows us to see all of the soft tissue, the vessels, the heart.

Whereas, when we're using the X-ray, we just sort of see this gray blob in the middle of the chest and we can't actually see where we're going.

We do not know of any significant risks or dangers of using MRI.

And I do think that iCMR will come to fruition and will really change the fields and hopefully eliminate X-ray from cardiac cardiac catheterization.

An interesting question to ask is, “Ted, if you had to do this all over again, knowing the possible consequences that now prevail on you, would you do it again?” And you would say?

Absolutely.

I'll tell you since 1869, things have changed in college football.

I often use the example of football players and chronic traumatic encephalopathy or CTE.

They play football and fans are yelling and screaming for them.

They don't understand that by cracking helmets all these years that they are sustaining irreversible brain damage.

The same is true in the cardiac catheterization laboratory.

Our physicians, nurses, and techs don't really realize or think about the long-term damage that they are being exposed to.

There's no effect from radiation when you're standing in the room.

You don't know you're being radiated.

You start to see these events and sometimes you need 20 or 30 years of bad safety and bad protection to recognize that these are what the long-term outcomes are potentially going to be.

And I think that's when you start to get the drive or the motivation for people to have awareness, and awareness kind of breeds innovation and change.

Honestly, I think we're our own worst enemies in this regard.

So, it's because it's our personal health.

We don't take it seriously enough.

In fact, I posted on Twitter last night, why is it that we all get excited when we hear a presentation and then we go back and we do very little about it?

And there are tools that are out there.

So, for example, there are real-time radiation monitors.

I bought them.

I couldn't even get the faculty to use them.

Smoking cigarettes.

When you're young, and you're healthy, and you start smoking, you're immortal.

Nothing's going to happen to you.

And so, you don't think about the consequences of tobacco.

When you start doing these radiation-related procedures, you don't think about it.

You're immortal.

My solution to solving the radiation issue was to take my badge, and my dad was the chief radiation officer, radiation physicist.

And I would put the badge in the drawer because - We all did that.

That's what we did.

But where's the badge?

When they came to me and said, “You've had too much radiation,” I'd say, “Well, what the hell do you think I'm going to do about it?” You think I'm going to quit doing cases?

I put it in the drawer.

I said, ”It won't be that much next month."

[laughs] It's interesting that one of the biggest pushbacks, one of the biggest obstacles we faced when trying to heighten this awareness was that it takes another 10 minutes to set up one of these new radiation protection systems.

It's remarkable to me.

An individual who works in a hospital, a doctor or a nurse, would push back on radiation safety.

It's very difficult to get hospital administrators and hospital systems to think this way.

It's very difficult to get managers in the hospital to understand this.

Quite frankly, they're not the ones being exposed.

So, like CTE and football, radiation has another similarity.

No one wants to talk about it.

We tried to talk to a physician whose hospital administration refused to purchase one of these new barrier systems.

So, he bought it with his own money.

And to no one's surprise, they also refused to let him appear in this film.

Did you get the e-mail chain and the text chain where it's like, “David, I don't think I can fight this.” People are afraid of these topics.

I think it's a prime example of what it is we're up against.

There is no doubt.

Listen, listen - An interventional cardiologist is willing to take the risk because they want to do the greater good.

And I think that's incredibly admirable.

And it's kind of a very unselfish individual that is willing to do that.

But at the end, I think that society and hospitals in particular, really owe it to the doctors to give them the safest environment possible for them to do their job.

I think it's the responsibility of the health systems that we work in to put you in the safest environment.

And currently we're not.

And there's better options out there.

What will happen eventually will be the same thing that happened in the NFL.

You'll have a group of people that have had orthopedic issues, or you'll have a group of people that have had cancers from the radiation.

You'll have a class action lawsuit.

I don't want this to sound like we're a bunch of victims.

I truly believe that we do have ownership of what we can and cannot do in the hospital.

Because at the end of the day, we are the players.

This idea that the administrators don't want to support it, or this or that, or the other thing, I just don't - I don't truly buy into it.

I think the good hospitals, the hospitals that really are known for being able to take care of the doctors, will generate a lot of loyalty, and that will be good for business.

I'm excited that we're going to be the first healthcare provider in Arizona to adopt this technology, but we know that these findings are really important for everybody to see so that they can also embrace this.

Your life's work is what has enabled that.

So, I wanted to say thank you for your life's work.

So, what do we know?

We know it's estimated that one in 25 of us high-volume operators will acquire a radiation-induced cancer, and one in 50 of us will die from such cancers.

We know 60% of us will have debilitating orthopedic issues after a 20-year career, nearly 57% higher than the general public.

Listen, I get it.

Cancer can't be proven, and we need more research or some kind of self-reporting registry to track these occurrences.

But I also know that I don't need a research study to tell me it's a good idea to wear a parachute when I jump out of a plane.

We know there is a problem.

We have solutions today.

But the question is, do we really care?

[music fading] [silence] I want to welcome everybody.

My name is Bob Foster.

I'm an interventional cardiologist.

To my left is Dr.

David Rizik, and I really appreciate him being here with me.

We're going to show clips from the film, Scattered Denial.

Dr.

Rizik was a big part of that, premiering it on April 28.

The reaction to Scattered Denial has been nothing less than spectacular.

It was released in 2024, and it was released nationally on PBS.

It was really the medical community that came together to see this documentary and then to insist that we keep the momentum going.

[music playing] The bottom line status quo is unacceptable.

The goal is to create a coalition that we can drive this over the finish line.

I think Scattered Denial was amazing.

The film opened the eyes of many.

So, many interventional cardiologists suffer from this, and as president of SCAI, my mission this past year and going forward is to help protect all of us.

These sorts of technologies are available.

How do you use them?

We need to lay the scientific foundation that, one, they're effective.

Two, they're not just good, but absolutely necessary.

We provided community protection for the entire cafe.

Look at those numbers.

And this is what I would have gotten to my head.

Every medical meeting I go to, people talk about this.

People talk about the subject or the issue of radiation protection in the cardiac catheterization laboratory.

People that I've never met send me e-mails.

The momentum from societies, from physicians, from health care systems.

We've seen this change and awareness like I've never seen before.

ORSIF, it's an educational platform that you can go to and find out who is in this space, what are the options.

We're actually putting together a symposium on radiation protection.

It's never been done before.

We're seeing it here at SCAI, where they have a whole summit of four hours on radiation protection.

How are we going to make the change?

They just came out with a multi-society consensus statement that says, “For our people within our society, this is what we're demanding now.” We've gone from basically ignoring this, denying that it is a problem, to making this front and center in just a couple of years.

There he is.

Oh my goodness.

Look at you.

Over the past several decades, for those of us who have the privilege of working in the cardiac catheterization laboratory, have realized that the occupational hazard of being an interventional cardiologist or a staff member working there is very high.

Lots of orthopedic injuries, lots of radiation-related injuries.

What there wasn't a lot of was actually data understanding why this was happening.

Our study, the Ergo Cath study, is a step in the direction of understanding the underlying mechanisms.

What we found was that 34% of the time that cath lab operators were working, they were in a high-risk cervical flexed position.

And this dramatically increases the axial load on their C-spine and downstream on their lumbar spine.

[music playing] Good to see you.

Great seeing you guys.

I'm telling you.

Look at that.

Is that a sight for sore eyes?

Amazing.

Amazing.

I'm still in the hospital.

I'll be here through the week.

It'll be almost a month.

And I've gone from literally being a functional quad to - I can use an arm and hand that I couldn't use.

My right leg works, but I can't walk without a walker yet.

And I think I'm making a complete comeback.

I didn't realize what was happening to me.

I knew that I had some cord compression.

It wasn't the typical sciatica.

It was clumsiness of the arms and a pain in the middle of the back.

It was like an incredibly deep kind of boring pain in your spinal column.

And I just laid on the floor for 15, 20 minutes.

It went away, but it came back the next day.

And I couldn't functionally use my arms.

I couldn't stand, so I was taken to the hospital.

In the hospital, I didn't know if I'd walk again.

I had no idea the pain, frustration, dehumanization, and depression that you get from being incapacitated.

And you see your whole professional life even worse than that.

The personal life that you neglected, frankly, because of your work-life imbalance.

When I married Dean, I knew what I was getting into, but I did not expect the wear and tear of being an interventional cardiologist.

Dean is a remarkable man, and he's been my friend for a long time.

When Dean had his event, and obviously, it was catastrophic.

I think it sent shockwaves throughout the whole interventional cardiology community.

When you watch a very close friend of yours go through something like Dean did, it has a powerful impact.

Taking care of our staff is the most important role that we do.

Whether the staff being our physicians or providers, a lot of the staff members are in these cases for 8 to 10 to 12 hours a day, depending on what they're doing.

So, that has always been heavily on my mind of what can we do to prevent that?

We had technologies available in the marketplace.

We were not interested in technologies that just protected one person in the room.

We really wanted to protect everybody.

So, this is the system we chose, and it consists of extra shielding around the patient to prevent all the scattered radiation from coming out and hitting the operators and the nurses around it.

It's a work in progress, but there are certain key positions that remain to be improved.

The systems we have aren't everything that we need today.

They're not going to be perfect.

They're not going to provide every single thing that someone would want.

I don't think it's time to wait, because waiting is just going to cause more harm to our staff and to our physicians.

It is really trying to tell the story of, what is the impact if we don't?

People want to leave.

They turn over.

We all know the time that it takes to train someone to be competent in the lab.

It's not a short amount of time.

Overall, I do believe this can be a good recruitment tool.

If I was looking at it 20 years ago, if I was younger and say, “I could go to a lab that has lead,” or “I could go to one that didn't,” I would absolutely want to pick the one that did not have the lead, because I think of the wear and tear on my body as a whole and that protection against the radiation.

I think all of us know that eventually we're not going to be able to work in the lab.

We either become frail, too old, or whatever happens.

I think you plan for that day in the back of your mind.

To me, I wasn't ready for that.

It's been a road back, and it's a blessing to be able to get back.

The cat's out of the bag.

There's no longer a debate about whether or not we are being occupationally exposed.

We are.

We have to be careful.

We can't move too fast.

We can't skip steps.

Then, we run the risk of going backwards, of taking the momentum out of this movement.

We still have to move forward intelligently with great science.

You know, the days where physicians took their badge off and put it in a drawer, we can never go back to those days because not knowing is part of the problem.

It's part of the denial associated with this whole space.

I think it's imperative that we know how much radiation we're getting in real-time.

I think it's a great idea because it alters your behavior in the lab.

When you know exactly how much radiation that you're getting with certain angles, with your table height, or with your type of procedure.

This is the badges that we use for cases.

They're color-coded, and you can wear them typically one in the collar area, one in the waist area, like this.

As you are doing the case, you can see exactly how much radiation you're receiving.

Every room is different, and every room, a lot of these rooms are doing different types of procedures.

They're standing in different positions, and they're accessed at different sites.

Some of these newer technologies that actually have evolved over the last couple of years is that now we have access to more access sites, more subspecialties, covering and protecting more people in the room.

About a year or so ago, I injured my elbow pretty substantially and ended up having multiple surgeries.

When I came back to the cath lab, putting on lead and taking off lead was almost not realistic.

I just couldn't do it.

As a woman in this field, nothing was designed for women.

Our lead doesn't fit us properly.

As a result of the newer technologies that have been developed from lead-free systems in the rooms and not actually having to wear the lead.

It gives the option that, as a female, you can both have a career, have a family, and not have to worry about being exposed to the radiation.

[people talking] My main focus was not only my own safety, but the safety of my staff in the room.

I picked this particular shielding device as being my favorite device.

One, because it allows the entire room to be lead-free, as well as the ease of mobility of the device.

This newer iteration actually hangs from the ceiling, which is the older iteration slid underneath the table.

And then, the patient would lay underneath of here, and then we can raise or lower this according to the patient's body habitus.

We have mobile shields that will also come out, and you can put those on either side.

We have the additional lead shields under the table with these lead shields down here.

We're all lead-free with the new system.

When it first came out, folks were kind of looking into it as, does this actually work?

Is this something that's going to be something that they trust?

But I think with a real-time dosimeter involved, it gave us an opportunity to gain that comfort, and then it was kind of, why are we still wearing lead?

[music playing] With the newer generation devices, one of the claims that has certainly panned out in preliminary data is that you can wear lighter lead, 0.125-millimeter lead, or in some cases, no lead at all.

I think a lot of us in surgery, I don't think we're quite there yet.

I've never worn light lead to date.

We prioritize maximizing reduction, and we'll eat the orthopedic injury.

The sting or the concern of overall radiation exposure is so great that we're not willing or don't yet feel comfortable enough to rid ourselves of even lighter lead, let alone no lead at all.

My interest in radiation safety came as a general surgery resident.

We conducted a study wearing real-time dosimeters of all three parties, the two surgeons and the trainee.

And we observed, perhaps not to his surprise, that it was the surgeon that stood immediately adjacent to the trainee absorbed significantly less radiation.

It doesn't take a whole lot of intellect to turn over your shoulder and say, “Hey, is this because me, as the trainee, I am serving as your radiation shield?” So, yes, I have concerns.

Hospitals, the fluoromachine manufacturers, why didn't any of them think of these issues?

How did they all let it get to this point?

I'm often asked who's to blame.

Well, it's a funny answer.

It's both and it's neither.

Neither because we have been focused on patient care.

We were so excited over the years of just being able to make patients better that we weren't thinking of safety.

And the answer is both because the minute this became an issue, the minute a safety issue was raised, it has been incumbent on hospitals and on manufacturers to address it immediately.

[music playing] As an industry, we have a collective responsibility to ensure we're continuously innovating and investing in research and development to challenge the laws of physics to ensure that we can deliver optimal image quality at the lowest dose.

And you're going to see what he's seeing in real-time.

If you look at the evolution of our angiography systems in the industry, the doses have been considerably lowered upwards to 60% to 80% from just 20 years ago.

A lot of that is due to the constant focus on how to redesign X-ray tubes where they don't necessarily need as much power to produce the imaging necessary.

In the old days, you would have to actually, for example, slide resistors in order to adjust your MA.

So, it was a very manual process.

But now that we have what we call automatic exposure control, again, the system is automatically modifying these parameters real-time.

It's almost like I like to say there's a physicist working in the X-ray tube for you.

So, one way we can really reduce radiation is by using other modality imaging such as CT or MR.

And we can actually bring that modality imaging into the lab to utilize whether if it's a reference point or road mapping or using that data to then overlay on our images.

So, we don't have to use X-ray to use the visualization.

We can use pre-procedural imaging to replace what would otherwise have to have used radiation to visualize.

I think this is a very exciting time because everyone is feeling the accountability to support one another and ensuring scattered radiation is reduced.

But also that we're coming up with solutions together to support one another in driving this movement.

I mean, I think just having the conversation was the first step.

There's virtually no corner of the country that hasn't been affected by this.

And it is now an expectation that the cardiac catheterization laboratory is going to be made a safer place for our healthcare workers.

Typically for coronary artery disease, we're on either the patient's right side or left side, but stationary.

For peripheral intervention, it's a whole ‘nother animal.

Oftentimes, I'm working at the foot, I'm working at the groin, or I'm working at the wrist and I'm working at the foot.

And I'm going back and forth manipulating my wires to try to get into a true lumen of an artery that's occluded.

[music playing] Patients coming in with a ruptured abdominal aortic aneurysm, literally dying, having already done chest compressions.

They're on the operating room table.

We get access from the groins and within minutes, we get a stent graft in to fix the hole in this ruptured aortic aneurysm.

And our final picture doesn't look great.

We immediately as surgeons shift our access point up to the upper extremity.

You can imagine in traditional radiation safety protection systems that are either number one, absent, or number two, extremely large and bulky to move large multi-hundred pound devices in a patient who's actively dying in front of you.

You can imagine the time, the attention, or more likely the ability just to discount and forego that radiation safety for the task at hand to save the patient.

These newer generation devices eliminate all of that mental distraction.

We instantly have this passive system that does not compromise any radiation safety whatsoever.

Not just for me, the patient, but for everyone in the room and allows us the seamless transition from the groin to the foot to the extremity.

Very commonly with complex aortic work, we'll have upper extremity access with one surgeon, lower extremity access with another surgeon.

Having this cocoon contains all of the beam that we do not want going anywhere else except for through the patient.

I think every time there's a new iteration of these radiation protection devices people start thinking about well how else can we advance it or how else can we make the device better.

I think there's still a learning curve with regards to operators wanting to use these solutions or even knowing that they're available.

You know we have an expression in interventional cardiology and that is retool or retire.

Part of the blame also falls on physicians.

Physicians have to be willing to look at new technology.

[vehicle sounds] I was four years old when my father joined St.

Francis Hospital.

Right from the beginning the only time that you'd see him is if you come to work with him.

And it's pretty amazing to come full circle that now I'm working here as an interventionalist.

I'm Evan Shlofmitz live from St.

Francis Hospital and I'm going to turn it over to the cath lab where Dr.

Allen Jeremias and Richard Shlofmitz are.

My partners were always worried about me because we do many cases, and I'm exposed to radiation over 40 years and we know it's a cumulative thing.

So, I'm not the most careful when it comes to my screens and my protection.

No you protect the back wall.

That's good.

It's an important wall.

It's an important wall.

But with all seriousness they said, “Look we have this new thing we want you to try,” and I'm not good at new things.

one of the highest volume operators in the world and there's no question he's probably having among the highest-volume exposure in the country.

And the question is, what can we do to reduce that?

And every time I'd bring up that discussion, his answer was, "I'm not changing my workflow."

I've been doing interventional cardiology for 40 years and every month someone's coming out with a new product.

And it's wonderful.

It's this.

It's that.

But I always tell people in industry, if something's not easy to use it's unlikely that the masses are going to use it.

When you look at radiation safety if it's going to be something that limits me from doing what I'm going to do, not going to happen.

I'm not going to use it.

He didn't want to do anything that was going to change things because he almost didn't care about himself.

And the angle that we had to come at was, well this is to protect the staff.

Because the staff is his family and when he knew that there was a solution that won't impact his workflow can reduce exposure to the entire staff, we knew we had a potential solution.

The beauty of this particular system is it doesn't impede anything for me.

It makes it user-friendly.

My workflow is beautiful.

I'm just doing my case.

I'm going to go to hover mode right now just before I get centered.

So, I'm not exposed to radiation at all right now.

I'm going to be blue.

I'm in hover mode.

It's pretty incredible.

It really looks like a game-changing technology now available, really for the first time.

Now, day three, we used it, and I mean, we feel much more secure.

I'm very encouraged about it.

The fact of the matter is that I've only been in the cath lab eight years, but it takes its toll.

It is amazing that our administration and our physicians really care about us being protected.

You guys want to come check out this new toy that we have?

We're the first generation of humankind who has stood in front of radiation for 40 years, worn 30 pounds of lead, and expected nothing to happen from it.

Generically, what we need to do is to try to figure out which system gives us the maximum protection and is flexible enough to do the wide range of procedures that we do.

We need to be able to get to the patient in a hurry if there's an emergency.

And it has to be more or less user-friendly.

I think that having it be integrated into our workflow so it doesn't take additional time.

Time is very costly.

So, I have three sons and they're amazing people because of my wife.

My wife really raised them.

I might not have been the greatest father.

I was here all the time.

I worked every day.

Did you ever worry about radiation?

I did worry about it, but I knew there was no stopping my husband.

He was gonna do as many cases as he could possibly do.

And I was just praying that the lead would work.

Also, I was glad we had already made our children so.

[chuckles] I hadn't really realized in all of his training what the actual career would look like and the amount of exposure.

Fortunately, we got pregnant very easily and didn't have to really think much about it.

I mean, I think that anybody who's exposed to to that much radiation on their day-to-day in their work definitely needs to have that level of protection.

Interventional cardiology is the greatest job in the world and we need to be healthy to take care of them.

Radiation safety is going to let us all meet that dream.

Progress or progress in making the cath lab a safer place is truly what I call incremental.

Very much the same way as safety in the automotive industry has been incremental.

When I was a kid, we didn't have seat belts in cars.

Now, cars virtually break on their own to help prevent an accident.

I think that we should be using these technologies to reset what is allowable anymore.

We always use this ALARA, and ALARA is as low as reasonably achievable.

Well, now we can achieve much lower levels.

So, many hospitals are really not compliant with ALARA because there are ways to achieve a lower level.

So, if it's a procedure that you can use one of these advanced technologies that allow you to go lead-free, you should do that.

If you're doing procedures that those will not work, but you could reduce to lighter lead, do that.

If it's procedures that you're working right on the camera and a barrier technology gets in the way, then at least provide the best and the safest lead aprons that are fitted for the person, for their size with the right amount of attenuation for the procedures that they do, and have disposable barriers that are placed in strategic situations to lower that scatter radiation.

There are no clear guidelines that are consistent from state to state.

I think the minute one state senator gets legislation that is going to mandate a safer cath lab, I think there's going to be a domino effect from state to state all around the country.

So, far everything we've been talking about is in the spirit of protecting the cath lab staff.

But we can learn a thing or two from a specialty within our specialty.

Pediatric cardiology.

Why?

Because what often drives innovation isn't the need for occupational safety.

What has driven innovation is the need to treat patients.

And when you need to find new ways to protect and treat the most vulnerable patients, amazing advancements.

Amazing achievements can be made.

Children with congenital heart disease have a higher risk of cancer than the normal population.

Radiation as we all know, has cumulative effects.

In pediatric patients it's even more critical because they get multitude of these cath lab procedures, radiation procedures.

It's not a one-time procedure for them.

That's different from an adult who has lived their entire life with minimal to no radiation and come age 60 or 70 or 80, gets a coronary artery disease-related stent.

Babies' brain and heart and lungs, rest of the body as they go from neonates post-birth to the first three to four years of life, there is rapid changes.

During this phase, the less we do to affect any change in them, the better it is.

The vision is to replace X-rays with MRI.

The real advantage with cardiac MRI is not only does it give you anatomical information, but you can really derive a lot of physiological and functional information.

In the cath lab, we are “seeing something,” but we are not really seeing.

We are imagining three dimensionality in our brain.

It's the difference between watching a television and actually seeing a person in real life.

Our team at Children's Health has been doing iCMR since 2014, 2015 or so, and have done close to 150 patients who are at the highest risk for long-term X-ray-related problems.

We use a wire in the magnet.

There is only one wire that is FDA-approved here in the country to get to all the different parts of the heart.

We can't take anything that is metal, which is 99% of our cath lab equipment.

Some of these patients have to go to the cath lab because the technology is not there yet to do ballooning or stenting with the current magnet that we have.

I'm hopeful in future though with the low-field system, there is this potential that we may be able to do those interventional procedures in the magnet itself.

Equipment is one part, but the even more important Equipment is one part, but the even more important part is to have a team on board to guarantee absolute safety.

have a team on board to guarantee absolute safety.

This is our MRI safety checklist.

With any technology, you have to first show that it's feasible.

And I think we've achieved that.

The case that really got us to the next level is our first in the United States interventional procedure that we did as a live case.

And it's time that we see the next revolution, and maybe that revolution is MR-based cardiac catheterization procedures.

So, what are the remaining controversies?

Lead, no lead.

Who's to blame?

Who's going to pay?

We need more proof, inner fighting and lawsuits.

[music playing] You know I still consider myself relatively young, but my wife will tell me I walk like my father when I wake up in the morning.

Young guys in our field think that that's not going to happen to them.

That was me.

Don't think about your time right now in the lab.

Think about what your life's going to be like when you retire.

I think if you look at these technologies it's evolving in all areas.

The lead that we use, I mean, I can carry this with my pinky.

The reality of it is that these new advanced radiation devices have been shown in studies to actually be superior in whole body protection because they cover more of your body.

So, I think the key to this is if you're going to be able to tell people that they can come out of the lead apron, you've got to be able to show that with some data.

If we can do that and we show you, you in particular, and where you are in the hospital that you're in and the system that you're using and the procedures that you're performing and where you stand, if we can show you that your levels of radiation are extremely low, 99% plus attenuation, then you should be able to have the option of coming out of your lead apron.

[music playing] Even as a young, new attending surgeon, I had by far the highest radiation dose across the health system.

What will it take for me to rid the lead?

Probably disabling low back pain.

Because the threat, this invisible threat of radiation safety, which I long have sort of referred to as the asbestos of our generation, is too great.

[music playing] The preceding program was made possible by the Honor Health Foundation.

[music playing]