The ALARA+ (As Low And As Light As Reasonably Achievable) Coalition, comprised of nine medical societies, has released a suite of resources to help hospital leadership and decision makers implement enhanced radiation and occupational safety guidelines for clinicians and staff working in the fluoroscopy laboratory.
The new implementation toolkits translate recently published ALARA+ guidelines into practical steps to protect Cath lab team members from both occupational radiation exposure and orthopaedic injuries related to protective equipment.
The four ALARA+ toolkits include:
- A radiation safety foundations toolkit, providing education on the fundamentals of occupational radiation exposure and orthopaedic risk in fluoroscopy laboratories, the evidence base behind the ALARA+ framework, and dosimetry and monitoring best practices for the full Cath lab team.
- An enhanced radiation protection device technologies (ERPD) implementation toolkit, offering an overview of available ERPD, clinical evidence, and practical guidance on evaluation, implementation, and workflow integration.
- An economic and business toolkit, featuring a return-on-investment framework, funding and phased-implementation pathways, and talking points to help hospital administrators and Cath lab directors build the financial case for enhanced radiation protection; and
- An advocacy toolkit, including model policy language, a summary of the gap between current US occupational dose limits and international standards, and resources members can use to advocate for modernised radiation safety regulations and safer labs within their institutions.
The ALARA+ resources build on the summit on radiation and orthopaedics risks in fluoroscopic laboratories and a 2026 a multi-society expert consensus statement. They call on healthcare institutions, manufacturers, regulators, and professional societies to share responsibility for occupational safety in fluoroscopy laboratories; adopt ERPDs; modernise federal and state radiation safety regulations; measure and report radiation safety performance; design safer fluoroscopy laboratories; and expand education, training, and research.
“Interventional radiologists and our care teams depend on fluoroscopy to deliver minimally invasive, lifesaving treatments, but that work should not come at the expense of our long-term health,” said Saher S Sabri, president of the Society of Interventional Radiology (SIR). “The ALARA+ Coalition toolkit gives hospitals, clinicians and policymakers practical steps to strengthen radiation safety, reduce orthopaedic risk and make angio suites safer. SIR urges the interventional radiology (IR) community to use these resources to assess gaps and take action to protect the teams delivering this essential care.”
According to a 2023 a Society for Cardiovascular Angiography and Interventions (SCAI) survey on occupational health hazards in the cardiac catheterisation laboratory, nearly 60% of respondents reported orthopaedic injuries attributable to protective lead, and roughly one in five reported reducing their caseload or taking medical leave due to injury or radiation concerns. Among women respondents, 28% reported being discouraged from working in the Cath lab because of pregnancy or considering pregnancy—a barrier that deters women from entering fluoroscopy-based specialties at all and deepens shortages in a workforce already too thin to meet growing demand for lifesaving procedures.
The toolkits are endorsed by SCAI, American College of Cardiology (ACC), Alliance for Cardiovascular Professionals (ACVP), American Society of Echocardiography (ASE), Heart Rhythm Society (HRS), SIR, Society of Neurointerventional Surgery (SNIS), Society of Vascular and Interventional Neurology (SVIN), and the Society for Vascular Surgery (SVS).
