Re: Health Impacts of Radiation Exposure During PCI

My name is Elizabeth Crom Rainer. My husband, Dr. Joel H. Rainer, was an interventional cardiologist with a cardiology group in Northwest Alabama from 1984 until an oligodendroglioma brain tumor in his left parietal lobe forced him to stop practicing his profession in 2010. The tumor was removed in 2008, but grew back, as glioma tumors do. He passed away September 6, 2022, after many difficult years of dealing with it. Anyone who suggests glioblastoma is the worst brain tumor doesn't understand what people with oligodendroglioma deal with over a long period of time.

Joel finished his fellowship in Cardiology at Emory University in 1984. Though training was available to cardiologists, I think Dr. Rainer was in the first fellowship class from Emory offering invasive cardiology. He picked Emory specifically for learning that skill. As such, he used the first-generation cath machines which I believe used quite a bit more radiation than current machines. 

In the early 90s, Joel had known excess radiation exposure from the cath machine. The radiation safety officer surmised the wayward beam was bouncing off the lead shield to the left side of his head. They eventually got a new cath machine. We really didn't think much of it at the time other than the problem needed to be remedied.

He had no seizures or obvious tumor signs until his brain ran out of space for it to grow and the tumor had calcified and began to bleed. Removal in 2008 significantly affected him. His brain had compensated over a long period for the slow growing oligodendroglioma. Removal essentially caused a full head injury. By 2010, it was reality that no amount of rehabilitation would allow him to practice his beloved cardiology profession.

Because of his pacemaker, he couldn't be followed with MRIs until 2017. Watching with only CT scans from 2008-2017, the tumor regrew undetected from the margins and was inoperable when discovered with an MRI 9 years after the original tumor was removed. IMRT and chemo slowed things to give him five more years. In 2017, we connected the dots between the cath machine radiation exposure in the 90s with the slow-growing oligodendroglioma removed in 2008. 

I found this article in Cath Lab Digest while looking for information regarding the association of interventional cardiologists and primary brain tumors.

I feel my husband should be on some kind of registration. Dr. Rainer is unique in that he had known radiation exposure from the cath machine in the early 90s, and because the tumor caused no obvious symptoms or seizures, the tumor grew unchecked until it ran out of space to grow. I know these things don't always have answers, but the left parietal lobe placement and the timeline indicate that the early model cath machine was the source of his injury. In any case, he needs to be added to the statistics of interventional cardiologists who had primary brain tumors.

At a minimum, I feel everyone in a cath lab should be wearing a radiation badge, any findings should be taken seriously, and there needs to be a central data reporting place, so people are followed over time if they have known exposure. Hopefully, the newer machines use less radiation.

Elizabeth Rainer

ecrainer@gmail.com