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BackTable / MSK / Article
Radiation Safety in Interventional Radiology: An Overlooked Occupational Risk?
Audrey Qian • Updated Jul 10, 2025 • 46 hits
Medical imaging, such as X-rays and computed tomography (CT) scans, has played a large part in accurately diagnosing patients at an earlier stage. However, its increasing use over the past decade has exposed patients and practitioners to ionizing radiation, which even in low doses, can cause direct DNA damage via oxidative reactions. As many as 2% of cancer cases can be linked to CT exposure alone [1].
Interventionalists have a large occupational risk of radiation exposure, especially in interventional radiology, who were reported to have lagged behind cardiology in implementing systemic radiation protection measures. Yet, management of radiation exposure remains under-discussed. Neuroradiologist Dr. Kieran Murphy explains the occupational risks and management of radiation exposure in interventional radiology, emphasizing the urgent need for individual vigilance and institutional accountability.
This article features excerpts from the BackTable MSK Podcast. We’ve provided the highlight reel in this article, and you can listen to the full podcast below.
The BackTable MSK Brief
• Occupational radiation exposure in interventional radiology poses long-term genetic risks, particularly in DNA damage and potential heritability through mutation of the mitochondrial DNA.
• Antioxidant therapies, including formulations of DNA Halo, show promise in reducing oxidative DNA damage.
• Protective equipment were found to have hidden toxicity risks as surface swabs revealed 63% of lead aprons carrying free lead dust. This issue increases the risk of toxic inhalation or ingestion, highlighting the need for regular monitoring.
• Dr. Murphy calls for institutional accountability, including genetic screening and investment in safer practices, to protect current and future clinicians.
Table of Contents
(1) Radiation, DNA Damage & Occupational Risk
(2) Institutional Responsibility in Radiation Safety
Radiation, DNA Damage & Occupational Risk
Dr. Murphy draws attention to a critical yet often overlooked concern in interventional radiology: the long-term effects of occupational radiation exposure, particularly DNA damage and its potential heritability through mitochondrial DNA mutations. This issue is especially relevant for biologically female interventionalists, given the maternal inheritance of mitochondrial DNA.
To mitigate radiation-induced oxidative stress, antioxidant therapies, such as the formulation of DNA Halo, have shown promise in reducing DNA strand breaks. However, these strategies may not be enough – a broader cultural and institutional shift is necessary to prioritize radiation safety as an occupational health mandate. One recommendation is the implementation of genetic screening protocols to identify physicians with heightened radiation sensitivity before they enter high-exposure specialties.
[Dr. Jacob Fleming]
I think this is probably a good segue into another thing you mentioned briefly in your conversation with Aaron is this DNA Halo. This is a fascinating topic, and I think really important, as you mentioned in that discussion. Ironically, in radiology, we don't seem to have the same focus on radiation safety as maybe in other fields like interventional cardiology, and we can sometimes be a bit cavalier about it. Tell us about the experience with DNA Halo, the insights that led to that, and where does this fit in for us?
[Dr. Kieran Murphy]
I think because of the long indwelling or time for tumors to develop or issues to develop after radiation exposure, we're probably not yet in the time frame where our colleagues begin to manifest the injuries they have sustained. We seem to have forgotten that the original founders of radiology lost toes and fingers and eyes and noses from standing in the X-ray beam. This is an occupational health issue. This needs to be something that we realize the hospital has a responsibility for, not us. Now, sadly, we often don't work for the hospital. The techs and nurses do, but we have occupational radiation exposure, just like a nuclear power station, just like a young officer in a submarine.
Our radiation exposure needs to be a problem for the hospital, and it be something that hospitals step up and take seriously. Our societies have fallen behind in this. They continue to talk about lead and the inverse square law and stuff like that. They need to just get their stuff together. I spent a long time studying the mechanism of action. I'll keep using that word, the mechanism of action of radiation injury. It's an oxidative injury of DNA, and antioxidants can block that. How this came about for me was, I was bothered by this. I was getting lots of radiation, and I came home from work, and my mother-in-law had a list of medications not to take prior to radiation therapy for her breast cancer.
They were all antioxidants. I look at this going like, "Jesus, if a gray of radiation to your axilla can be interfered with by vitamin C and some other antioxidants taken orally, what would that do for millisieverts?" My son, Ronan, and the dog Cora and I went for a walk, and the dog met another dog, and they were playing together. The owner of the other dog asked me, "What do you do?" I started talking about antioxidants, and Ivan D'Souza, the man's name I later found out, said, "I make antioxidants." It's like, "Whoa, shit." I did a bunch of experiments on myself and then two of my friends, Joe Barfitt and Dave Nicholas, got involved.
We would meet around 6 in the morning, we would draw our blood, we made a phantom, we would CT the blood, and then we would measure breaks with gamma H2AX and p53. Then we started to take Ivan's antioxidants and felt great, but it made us hypertensive, so we realized that was bad. Then I developed a formulation, did a prospective randomized study in humans having technetium MDP bone scans, and then that worked, 90% reduction in DNA breaks. Then, again, accidental conversation. Many of these things happen by accident, just from conversations. I met a mitochondrial disorders neurologist who was able to guide me on perfecting the formulation to protect mitochondria. Mitochondrial DNA is purely maternal. That is so cool.
[Dr. Jacob Fleming]
Yes, I've always found that really interesting.
[Dr. Kieran Murphy]
Yes. Why? Protecting that is important because it's 10 times more sensitive to radiation than nuclear DNA, and it could be transmitted across generations. Women interventionalists. Get the right word. Biologically female-- Biologically-- I think, that's the right phrase, right? Biologically female interventionalists.
It's important to be sensitive to that. Could potentially transmit mutations in mitochondrial DNA across generations. No one's even talking about that.
[Dr. Jacob Fleming]
No, I've never heard that talked about.
[Dr. Kieran Murphy]
Then the other thing is, should we be screened for mutations that would impair our ability to repair DNA damage prior to choosing our fellowship? Say, if you got a Smith syndrome, or you're BRCA1 or 2, or you're Askinazi, and you've inherited some odd DNA repair apparatus abnormality, or you've got hereditary telangiectasia. One of the other things that is a p53 mutation, that's 50% of the cancer risks come from p53 mutations, then you shouldn't be an INR or IR, or interventional cardiologist. You should do ultrasound-guided biopsies. We should know that, and we don't do that. It's sloppy, and we just need to do better.
Those are conversations that are not happening, because people are so focused on the rock, and billing, and money, and it's stupid. Those things are short-term goals, not long-term things for our safety, security, sanity, and our careers.
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Institutional Responsibility in Radiation Safety
Surface testing of radiation protection equipment reveals a concerning finding: 63% of protective aprons had free lead dust, exposing practitioners to additional toxic risks through inhalation or ingestion. Additionally, years of occupational radiation exposure can lead to upregulation of DNA repair mechanisms in experienced interventionalists, whereas early-career interventionalists remain more vulnerable to damage due to slower DNA repair capacity. The long-term consequences of unmitigated radiation injury, including affected careers, illustrates an urgent need for systemic intervention. Dr. Murphy advocates for institutional responsibility and proactive management of occupational exposure, asserting that while individual practices like using proper shielding and technique are important, they remain insufficient without systemic reform.
[Dr. Jacob Fleming]
How do you see us as interventionalists? What are some immediate steps we can take? As you said, this really should be an institutional effort, but on an individual level, what are the types of things that we can do? Is DNA Halo something that you think we should be--?
[Dr. Kieran Murphy]
I think we need to look at our lead. Oh, the other fun thing we did, one of the most fun projects. I have a lot of students that I work with, and our job is to show them that medicine is fun, medicine is a liberal art. We swabbed the surface of the lead in all our hospitals, looking for free lead on the surface. We found 63% of the lead aprons have free lead dust on the surface. There's no safe level for lead in your system. Now, when I looked at the literature, I was bummed. I wanted to measure lead levels from people's hair, and somebody had already done it, and it's abnormal. We're ingesting this lead dust.
Again, we should know this. Why don't we know this? We have to try harder. We want to wear the best lead we can. We want to have the best lead shields we can. We want to have the best lead table-side skirts, one of those things that we can. We want to use those bunkers as much as possible. If you look at the Rampart folks, they've made trans-radial access to the heart lead-free, because their bunker is so good. That's a $200,000, $300,000 investment. Hospitals would have to buy that. They're going to say, "Oh, the budgets--" What they're really saying is, "You could get radiated. That's okay." It's not okay. We need to make a bigger fuss about this.
When our older machinery is radiating people, that's radiating us. Our nurses are putting their heads right beside the I.I. when they talk to the patient. Our techs are moving around, positioning things. There's ample literature to show that there's no safe level and that individuals vary in their ability to repair the damage. These are occupational, institutional responsibilities, and we need to make that clear to the institutions we work in.
[Dr. Jacob Fleming]
Absolutely. I couldn't agree more. I think you've raised a lot of really interesting things when you think about it as a field in terms of DNA mutations. Is that something that we should be checking for in potential people who are going to be spending their entire life next to a C-arm?
[Dr. Kieran Murphy]
Right. There's fun stuff, too, looking at mutations in the DNA. We've noticed this in the work that we did. Most complex research I've ever done. We were able to show that more experienced or older interventionalists have more DNA repair ability, more rapid repair, because they're used to-- |They've up-regulated the repair apparatus. Whereas younger faculty don't. A ton of papers in the cardiology literature show that folks with mutations have more cancer. Those papers exist, and they're in the peer-reviewed literature.
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Cite This Podcast
BackTable, LLC (Producer). (2025, April 8). Ep. 74 – Diagnosis & Treatment of Tarlov Cysts [Audio podcast]. Retrieved from https://www.backtable.com
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