Article Figures & Data
Figures
- Figure 1
- Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of this meta-analysis
- Figure 2
- Forest plot illustrating the results of cataract outcomes in non-exposed and exposed groups.
- Figure 3
- Forest plot illustrating the results of nuclear opacity in non-exposed and exposed groups.
- Figure 4
- Forest plot illustrating the results of cortical opacity in non-exposed and exposed groups.
- Figure 5
- Forest plot illustrating the results of posterior subcapsular opacity in non-exposed and exposed groups.
- Figure 6
- Forest plot illustrating the results of any lens opacity in non-exposed and exposed groups.
- Figure 7
- Funnel plots demonstrating no proof of publication bias in the included articles in terms of A) cataract formation, B) nuclear opacity, C) cortical opacity, D) posterior subcapsular opacity, and E) any lens opacity.
Tables
- Table 1
- List of articles used in this meta-analysis with their geographic distribution, study design, participant characteristics, and outcomes.
Study Study design Country Participants (occupational category) Age (years) Duration of occupational work Lens scoring system Outcomes (lens area assessed) Radiation dose n Exposed Non-exposed Andreassi et al44 Cohort Italy 746 466 (218 ICs and electrophysiologists, 191 nurses, and 57 technicians) 280 35-53 5-24 years ND Cataract Median lifetime effective dose physicians: 21 mSv nurses: 7 mSv Auvinen et al33 Cohort Finland 37 21 (14 radiologists, 2 interventional radiologists, 3 cardiologists, and 2 surgeons) 16 (physicians excluding radiologists and cardiologists) 45-74 At least 15 years LOCS II Posterior subcapsular, cortical change, nuclear opalescence, nuclear color, nuclear opacities Mean cumulative radiation dose based on dosimeter readings: 111 mSv Barbosa et al34 Cross-sectional Brazil 200 112 ICs and healthcare workers in cardiac hemodynamics: nurse, physician, technician, or technologist 88 (cardiologists not exposed to radiation) 36-66 62% of the professionals: <20 years of work, and 31% presented between 5-10 years of work. LOCS III Posterior subcapsular, lens opacities, cortical cataract ND Ciraj-Bjelac et al18 Cohort Austria 89 56 ICs and 11 nurses working in interventional cardiology 22 age- and gender-matched unexposed healthcare staff 25-64 1-33 MF scoring system Posterior lens changes 0.01-43 Gy Ciraj-Bjelac et al17 Cohort Austria 86 52 healthcare workers in interventional cardiology 34 age- and gender-matched unexposed healthcare staff 19-67 1-20 MF scoring system Posterior lens changes Cumulative dose: 0.026-21 Sv Domienik-Andrzejewska et al45 Cohort Poland 147 69 (interventional cardiologists) 78 physicians, scientific/administrative staff, and nurses 37-68 5-36 years LOCS III Nuclear opalescence, nuclear color, cortical opacities, posterior subcapsular opacities ICs: 224 mSv (left eye)85 mSv (right eye) Jacob et al36 Cross-sectional France 205 106 ICs 99 non-medical workers >40 ND LOCS III Any lens opacities, nuclear opacities, cortical opacities, posterior subcapsular opacities ND Karatasakis et al46 Cross-sectional USA 117 99 ICs and cath-lab staff 18 participants (industry, research staff, and others) 36-60 ND MF scale Any lens opacities, cortical and posterior subcapsular lens changes, Frank opacities Cumulative radiation dose to the lens: 0.1-22.5 Gy (Mean: 4.5) Matsubara et al40 Cohort Thailand 85 Cardiac catheterization laboratories staff: 7 ICs, 41 nurses, and technologists 37 age- and gender-matched volunteers 19-59 0.4-35 years MF scale Posterior lens opacities Cumulative radiation dose to the lens: 0.03-8.5 Sv Milacic et al47 Cohort Serbia 3240 1560 health workers 1680 health workers 28-52 6-26 years ND Cataract Equivalent doses 0.5-8 μSv/h Rajabi et al48 Cohort Iran 95 81 interventional cardiology members (44 ICs and 37 technicians) 14 nurses not working in interventional sites 26-54 At least 4 years LOCS III Cataract At least 1 mSv for at least 4 years Scheidemann-Wesp et al49 Cohort Germany 61 17 ICs 18 physicians 37-75 8-50 years LOCS III Nuclear opacity, cortical opacity ND Vano et al19 Cohort Colombia and Uruguay 209 58 interventional cardiologists and 58 nurses and technicians 93 unexposed non-healthcare workers of similar age 20-69 1-40 MF scale Posterior subcapsular lens opacities Cumulative lens dose range: 0.1-27 Sv Vano et al50 Cohort Argentina, Colombia, and Uruguay 145 54 ICs and 69 nurses and technicians 91 non-medical professionals 20-66 4-25 MF scale Posterior subcapsular lens changes Cumulative eye dose range: 0.1-18.9 Sv Yuan et al51 Cross-sectional Taiwan 1866 733 cardiologists performing cardiac catheterization 988 cardiologists not performing cardiac catheterization 35-50 ND ND Cataract ND ICs: interventional cardiologists, ND: not defined, mSv: millisievert, LOCS II: Lens Opacities Classification System, version II, LOCS III: The Lens Opacities Classification System III, Gy: the gray, Sv: stroke volume, cath-lab: catheterization laboratory, MF: Modified Merriam-Focht, μSv/h: micro-Sieverts/hour
- Table 2
- The quality evaluation of the cohort studies using the Modified Newcastle-Ottawa scale.
Articles Selection Comparability Outcome Quality score Representativeness of the sample Selection of non-exposed group Ascertainment of exposure Outcome absent at the start of study Cohort statistical analysis Evaluation of outcome Sufficient follow-up duration for outcomes to occur Adequacy of follow-up Andreassi et al44 ★ 0 ★ 0 ★ 0 ★ ★ Fair Auvinen et al33 ★ ★ ★ ★ ★ ★ ★ ★ Good Ciraj-Bjelac et al18 ★ 0 ★ ★ ★ ★ ★ ★ Fair Ciraj-Bjelac et al17 ★ 0 ★ ★ ★ ★ ★ ★ Fair Domienik-Andrzejewska et al45 ★ ★ ★ 0 ★ ★ ★ ★ Good Matsubara et al40 ★ 0 ★ ★ ★ ★ ★ ★ Fair Milacic et al47 ★ ★ ★ ★ ★ 0 ★ ★ Good Rajabi et al48 ★ 0 ★ ★ ★ ★ ★ ★ Fair Scheidemann-Wesp et al49 ★ ★ 0 0 ★ ★ ★ ★ Fair Vano et al19 ★ 0 ★ ★ ★ ★ ★ ★ Fair Vano et al50 ★ 0 ★ ★ ★ ★ ★ ★ Fair ★Quality score assigned for each category as per the Newcastle-Ottawa Scale criteria
- Table 3
- The quality evaluation of the cross-sectional studies using the Modified Newcastle-Ottawa scale.
Studies Selection Comparability Outcome Quality score Representativeness of sample Sample size Comparability of non-respondents Ascertainment of exposure Statistical analysis design characteristics Evaluation of outcome Statistical analysis Barbosa et al34 ★ ★ ★ 0 ★★ ★ ★ Good Jacob et al36 ★ ★ ★ 0 ★★ ★ ★ Good Karatasakis et al46 ★ ★ ★ ★ ★★ ★ ★ Good Yuan et al51 ★ ★ ★ 0 ★★ ★ ★ Good ★Quality score assigned for each category as per the Newcastle-Ottawa Scale criteria
Outcomes/study excluded Odds ratio (95% CI) P-values Cataract formation Andreassi et al44 4.94 (4.21-5.79) <0.00001 Milacic et al47 4.15 (2.01-8.56) 0.0001 Rajabi et al48 4.90 (4.18-5.74) <0.00001 Yuan et al51 5.12 (4.36-6.02) <0.00001 Nuclear opacity Auvinen et al33 0.85 (0.70-1.02) 0.09 Domienik-Andrzejewska et al45 0.85 (0.70-1.03) 0.10 Jacob et al36 0.78 (0.57-1.05) 0.11 Karatasakis et al46 0.80 (0.68-0.96) 0.01 Scheidemann-Wesp et al49 0.86 (0.72-1.03) 0.10 Cortical opacity Auvinen et al33 0.92 (0.67-1.26) 0.61 Barbosa et al34 0.78 (0.56-1.08) 0.13 Domienik-Andrzejewska et al45 0.88 (0.61-1.27) 0.49 Jacob et al36 0.94 (0.63-1.39) 0.74 Karatasakis et al46 0.85 (0.63-1.15) 0.29 Scheidemann-Wesp et al49 0.86 (0.64-1.17) 0.34 Posterior subcapsular opacity Auvinen et al33 3.28 (2.40-4.47) <0.00001 Barbosa et al34 3.13 (2.29-4.29) <0.00001 Ciraj-bjelac et al18 3.11 (2.27-4.26) <0.00001 Ciraj-bjelac et al17 3.42 (2.44-4.81) <0.00001 Domienik-Andrzejewska et al45 3.48 (2.52-4.79) <0.00001 Jacob et al36 3.24 (2.34-4.49) <0.00001 Karatasakis et al46 3.34 (2.44-4.56) <0.00001 Matsubara et al40 3.15 (2.31-4.31) <0.00001 Vano et al19 3.51 (2.46-4.99) <0.00001 Vano et al50 2.93 (2.06-4.16) <0.00001 Any lens opacity Barbosa et al34 2.55 (0.36-18.17) 0.35 Karatasakis et al46 2.20 (1.13-4.28) 0.02 CI: confidence interval
Subgroups No. of studies Risk ratio (95% CI) P-values Heterogeneity Chi2 I2 P-values Study design Cohort 7 3.20 (2.28-4.49) <0.0001 6.69 10% 0.35 Cross-sectional 3 3.53 (1.70-7.31) 0.0007 2.11 5% 0.35 Radiation dose <1 Sv 2 1.36 (0.48-3.82) 0.57 0.31 0% 0.58 ≥1 Sv 6 3.38 (2.37-4.82) <0.0001 5.25 5% 0.39 Study period Before 2015 6 3.33 (2.37-4.68) <0.0001 3.15 0% 0.68 After 2015 4 2.95 (1.42-6.11) 0.004 5.44 45% 0.14 Occupational work Physicians (radiologists, interventional radiologists, cardiologists, and surgeons) 1 2.29 (0.26-19.97) 0.45 ND ND ND Interventional cardiologists 9 3.85 (2.79-5.30) <0.0001 9.60 17% 0.29 Technicians 2 2.08 (0.96-4.50) 0.06 0.14 0% 0.70 Nurses 3 4.00 (1.41-11.30) 0.009 2.73 17% 0.30 Technicians and nurses 2 2.88 (1.75-4.72) <0.0001 2.73 63% 0.10 No.: number, CI: confidence interval, Chi2: Chi-square test, Sv: stroke volume, ND: not defined
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