Occupational Hazards in Cardiac Catheterization Laboratories: Radiation and Beyond-ANMCO Position Paper Update 2026.

Interventional cardiology has profoundly transformed the management of cardiovascular disease; however, working within the cardiac catheterization laboratory exposes healthcare professionals to substantial occupational hazards. Four principal risks can be identified: (i) malignancy and non-malignant sequelae related to chronic exposure to ionizing radiation; (ii) musculoskeletal injury associated with prolonged use of heavy radioprotective equipment; (iii) exposure to blood-borne pathogens and other infectious agents; and (iv) work-related psychological strain. Among these, cumulative radiation exposure remains the most consequential and historically under-recognized threat. Although the radiation dose which operators receive during a single procedure is markedly lower than that delivered to patients, healthcare professionals are subjected to repeated, lifelong exposure. For a high-volume interventional cardiologist, the annual effective dose may substantially exceed that of other radiation-exposed professionals, including nuclear industry workers and diagnostic radiologists. Importantly, unlike radiologists, many cardiologists receive limited formal training in radiation physics and radiobiology, which may lead to limited awareness of dose-optimization strategies and stochastic risk. Contemporary epidemiological evidence has refined our understanding of the biological effects of chronic low-dose and low-dose-rate radiation. Risk estimates for malignancy have progressively increased as follow-up durations have lengthened and methodological approaches have improved. Moreover, emerging data suggest that sustained low-dose exposure may confer an elevated risk of cardiovascular disease, thereby extending concern beyond oncological endpoints. Occupational exposure varies greatly depending on the location: doses to the head can be several times higher than doses to the chest, with a predominance on the left side attributable to the position of the operator in relation to the X-ray source. In addition to the well-established association with posterior subcapsular cataracts, observational studies have reported potential links between long-term occupational exposure and neurodegenerative disorders, including Alzheimer's and Parkinson's diseases, although causality remains to be definitively established. Mitigation of these risks necessitates a paradigm shift towards a rigorous culture of radiation safety. Institutional commitment is essential, encompassing advanced shielding systems, ceiling-suspended protection, real-time dosimetry with immediate feedback, and systematic optimization of imaging protocols. Ultimately, the future of the field may depend on the progressive adoption of radiation-sparing and radiation-free technologies, including intracardiac and intracoronary ultrasound, electro anatomical mapping systems, and non-fluoroscopic navigation platforms. In parallel, robot-assisted procedures enable remote manipulation of the catheter promise to reduce the operator's direct exposure. The pursuit of a zero-radiation environment in the workplace should not be considered an ambitious ideal but a strategic priority to safeguard the next generation of interventional cardiologists.