Future of EP/interventional work radiation free

[futtyMD]

Hi everyone, I am currently a first year internist really passionate about cardiology. I will soon most likely be pursuing a PHD in this field.
However, my biggest fears are radiation and ortho issues from lead use. I've worn those heavy lead suits before and usually get terrible pain after 2-3 hours. Furthermore, I have a family history of some genetic cancers.
I do like the procedural side of things but am worried about life long risk of radiation exposure (not too concerned as a resident as it is only a few years).
I was thinking of going into electrophysiology or interventional work. I was wondering if you people could give me their opinion on the future of radiation free procedures?

- I've heard that electrophysiology has quite minimal fluroscopy use and only requires angio for the very inital stages of the procedure. Is this true?
This cardiologist at Hopkins does not use radiation but a 3D mapping system but she is in paediatrics so I'm sure the anatomical considerations may be different? Treating Arrhythmias Without Radiation
I will be practicing in probably a decade's time so am willing to wait for fruitition.
There are a few techniques being developed such as the one above such as U/S guided electrophysiology or a magenetic tip that can be detected via MRI

- with interventional work, could the above methods work as well? Also has anyone had any experience or exposure to provide an opinion about the future of cath guided procedures? (Robotic technology is finding its way into the cath lab)

If anyone could provide me with good news, I would be very happy. If not, I might do have to do the research on radiation free procedures myself

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[nlax30]

I’m EP and a lot of our procedures are certainly moving toward minimal or no-fluoro use. Will still be fluoro to some degree, especially if you do a lot of devices or extraction work but if you end up focusing or limiting to ablations then I think the radiation exposure would not be significant.

Ortho concerns are real. I have already had a herniated disk. I think there are ways to minimize the risk.... exercise, light weight lead, minimizing mead use when able to, etc. Most of the older docs I’ve spoken to (both interventional and EP) have had ortho issues at some point in their career. Though to be fair in their careers they used fluoro and lead much more than we do now but still a big worry.

What’s your career goal? Academic/research? Private practice? That could impact things as both are very procedural related fields that involve many additional years of training, and then adding a PhD in the mix if you’re shooting for more academic/research career then you may not be in the lab as much as if you were in private practice.

 

[futtyMD]

I’m EP and a lot of our procedures are certainly moving toward minimal or no-fluoro use. Will still be fluoro to some degree, especially if you do a lot of devices or extraction work but if you end up focusing or limiting to ablations then I think the radiation exposure would not be significant.

Ortho concerns are real. I have already had a herniated disk. I think there are ways to minimize the risk.... exercise, light weight lead, minimizing mead use when able to, etc. Most of the older docs I’ve spoken to (both interventional and EP) have had ortho issues at some point in their career. Though to be fair in their careers they used fluoro and lead much more than we do now but still a big worry.

What’s your career goal? Academic/research? Private practice? That could impact things as both are very procedural related fields that involve many additional years of training, and then adding a PhD in the mix if you’re shooting for more academic/research career then you may not be in the lab as much as if you were in private practice.

Hi nlax30, thanks for replying to me. That sounds very reassuring, might limit myself to just ablations down the line. I would love to work 2 days in the OR and then 3 days on the wards/clinic in general cardiology. Ideally a mix of both working in private practice and in academic.

To be honest though, I did prefer interventional more. I'm just curious as to why EP is able to move towards minimal fluro while interventional isn't? And why does extraction work/device management require more fluro? I'm sure there is some sort of physics explanation but I can't think of it at the moment!

 

[Rocher]

Hi nlax30, thanks for replying to me. That sounds very reassuring, might limit myself to just ablations down the line. I would love to work 2 days in the OR and then 3 days on the wards/clinic in general cardiology. Ideally a mix of both working in private practice and in academic.

To be honest though, I did prefer interventional more. I'm just curious as to why EP is able to move towards minimal fluro while interventional isn't? And why does extraction work/device management require more fluro? I'm sure there is some sort of physics explanation but I can't think of it at the moment!

EP can do fluoroless procedures because of the ability to build anatomic maps using electrical signals - interventional cannot do this because it's not really possible to map the coronary circulation using electrical signals, you need to shoot contrast down the coronaries and see the image under fluoro to know the anatomy. Similarly, it's hard to do some device implantations without using fluoro for similar reasons and building electroanatomic maps for device implantation is not very efficient. We use Zero Gravity suspended lead systems in our hospital so it's possible to go most of your career without actually wearing lead despite using fluoro.

You have a lot of time to decide, you're early enough that you really don't know enough about either field to be making definite career decisions other than choosing cardiology. If you like cardiology, I would focus on getting into cardiology fellowship and then you'll really get a taste of each specialty. You might end up finding that you like something you never would have expected. I started my residency thinking I wanted to do heme/onc and am now about to start my EP fellowship.