By: Dr. Andrea Natale

A physician’s impact on a patient’s life can be profound. The ability to improve lives is often the motivation for our life-long mission to educate and advance medicine and technology.

For more than two decades as an electrophysiologist, I have seen and participated in many advances in medicine that have not only benefited individual patients but moved the medical community to further explore potential new and innovative ways to improve lives.



My career decision to pursue electrophysiology instead of interventional cardiology has, in some ways, protected me from the higher levels of occupational radiation exposure that interventionalists receive.

Interventionalists typically work at high exposure levels because they need crisper images. Electrophysiologists tend to use lower frame rates because we don’t require X-ray images with extremely high resolutions. Although I believe electrophysiologists are at an advantage, it does not lessen my concern for the impact radiation exposure has on my health and that of my colleagues.

Thankfully, awareness of radiation exposure among physicians is growing.

Organizations like ORSIF – the Organization for Occupational Radiation Safety in Interventional Fluoroscopy – are doing their part to generate widespread awareness for issues of occupational health hazards related to chronic, low-level exposure to ionizing radiation. ORSIF, an industry and physician partnership, has taken on the responsibility to change the way people think about radiation exposure to drive the industry to develop tools to better protect patients and physicians alike. As part of ORSIF’s awareness efforts, a documentary was recently released featuring renowned cardiovascular surgeon Dr. Ted Diethrich and his personal health struggles as a result of being exposed to ionizing radiation. Years of exposure during procedures resulted in carotid artery disease, cataracts, and may have caused a brain tumor.

Many of my colleagues, including myself, are most concerned about the potential risk of cancer related to radiation exposure.

Studies have shown that ionizing radiation exposure in the United States rose 74%, on a per-capita basis, from the early 1980s to 2006. Nearly half of the exposure is related to medical imaging. The cumulative effects of radiation exposure are well documented. The lifetime exposure levels of physicians are much higher than for patients, and have been linked to cataracts and thyroid disease.

While many of us are aware of the risks, I believe that we try not to think of the impact that chronic radiation exposure can have on our health and wellness. Perhaps some of us are in denial thinking, “it’s not going to happen to us.” This is my life, this is my job. How can I not do it? Responsively, technologies and procedures now exist to help clinicians minimize the risk of exposure.

I remember, when I began practicing medicine, some procedures would last 14 hours with incredible fluoroscopy time. Today, people would probably think we were crazy, but in those days it was not even talked about or monitored like it is today. In fact, it is now an ongoing conversation that we try to address in our daily practice, both for ourselves and our patients.

Now it’s standard protocol to inform the patient of the amount of radiation that they are exposed to during a procedure. Patients ask. Before, they didn’t ask. Patients are more aware of the risks involved and the industry needs to address their concerns.

The ALARA principles, along with adequate radiation protection training and diligently following protection protocols can significantly reduce radiation exposure. Awareness and adherence to these guidelines is key.

For physicians, the traditional precautions of personal protective equipment (PPE) such as lead vests, shields and proper positioning are all important, although it is well documented that over time doctors develop orthopedic injuries as a result of the heavy but necessary protective gear.

Over the past few years, the industry has worked toward reducing the window of exposure as well as employing new technologies and devices that significantly reduce radiation exposure levels and the orthopedic burden of traditional PPE, such as, light weight protective gear, remote systems and robotics. These strategies do work to offer protection, but while the system we have is good, it is not perfect and there is still more that can be done.

I also see great strides being made to go to fluoro-less procedures in electrophysiology. There are some of us that are doing this already. Clearly the industry is motivated to develop even better tools and we are closer to achieving that.

Better protection for physicians requires more education about the issue and diligence to use the technology we have to protect ourselves. Over the past 20 years, we have made tremendous progress in treating patients, and we now need to make the same progress in protecting our physicians and partners.

Dr. Natale, Executive Medical Director, Texas Cardiac Arrhythmia Institute

St. David’s Medical Center
Dr. Natale is a world recognized leader in the field of electrophysiology, as a clinician, academician and researcher. He has been an invited lecturer at more than 200 symposiums and conferences around the world, and is the author or co-author of hundreds of published articles on pacing and electrophysiology.

Dr. Natale pioneered a circumferential ultrasound vein-ablation system to correct atrial fibrillation and performed the procedure on the world’s first five patients. He also developed some of the current catheter-based cures for atrial fibrillation, and was the first electrophysiologist in the nation to perform percutaneous epicardial radiofrequency ablation, which is a treatment for people who fail conventional ablation. He also holds a patent for a device used to treat Atrial Fibrillation.