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The lead apron is a heavy piece of radiation protection that should be worn by all staff working in the angio suite but it increases the risk of musculoskeletal disorders (A). A lighter twopart coat (arrows) helps to distribute the weight across the shoulders and waist and must fit properly to improve radiation protection (B).
Source publication
Ergonomics in interventional radiology has not been thoroughly evaluated. Like any operators, interventional radiologists are exposed to the risk of work-related musculoskeletal disorders. The use of lead shielding to radiation exposure and the lack of ergonomic principles developed so far contribute to these disorders, which may potentially affect...
Contexts in source publication
Context 1
... central piece of shielding is the lead apron. The lead apron is a heavy piece (up to 15 pounds) of radiation protection that should be worn by all staff working in this environment (Figure 2A). However, it can increase pressure in the lumbar or cervical discs [8,39]. ...
Context 2
... correlation between anti-X apron-wearing and the occurrence of MSDs remains unclear, although the possible discomfort of workers using anti-X aprons appears more evident. Although further studies are needed to clarify the role of these protective devices in the generation of MSDs and to offer specific ergonomic solutions for IRs, it is now recommended to use a two-part coat or one with a suitable belt ( Figure 2B). Therefore, the weight is distributed across the shoulders and waist. ...
Context 3
... the items particularly important in the angio suite, the height of the table must be adjusted to allow the elbow joint to remain in a neutral position for most of the operating time to avoid the operator bending forward ( Figure 1A). Surgical tables positioned at a height up to 5 cm above the elbow height improves the position of operators ( Figure 2B). A study performed during laparoscopic procedures demonstrated that this position allows the biceps brachii to remain at less than 15% of maximum muscle activity while reducing back, shoulder, and wrist discomfort [45]. ...
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Methods
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Citations
... IO encompasses aspects of education, ergonomics, and economics for its success. [2][3][4] Education is central for IO adoption, with continuous medical education and training pivotal in keeping the community updated on emerging technologies. Ergonomics is crucial, with technologies prioritizing physician comfort and efficiency, mitigating occupational strain risks. ...
Interventional Oncology (IO) stands at the forefront of transformative cancer care, leveraging advanced imaging technologies and innovative interventions. This narrative review explores recent developments within IO, highlighting its potential impact facilitated by artificial intelligence (AI), personalized medicine and imaging innovations. The integration of AI in IO holds promise for accelerating tumour detection and characterization, guiding treatment strategies and refining predictive models. Imaging modalities, including functional MRI, PET and cone beam CT are reshaping imaging and precision. Navigation, fusion imaging, augmented reality and robotics have the potential to revolutionize procedural guidance and offer unparalleled accuracy. New developments are observed in embolization and ablative therapies. The pivotal role of genomics in treatment planning, targeted therapies and biomarkers for treatment response prediction underscore the personalization of IO. Quality of life assessment, minimizing side effects and long-term survivorship care emphasize patient-centred outcomes after IO treatment. The evolving landscape of IO training programs, simulation technologies and workforce competence ensures the field’s adaptability. Despite barriers to adoption, synergy between interventional radiologists’ proficiency and technological advancements hold promise in cancer care.
... Wilson-Stewart et al. reported that IVR nurses had higher lens doses than doctors [33]. Hence, it is important to measure the lens exposure of nurses and physicians accurately [34][35][36][37][38][39][40][41]. For this purpose, dosimeters should be worn as close to the eye as possible, and 3 mm dose equivalents should be measured [42]. ...
Although interventional radiology (IVR) is preferred over surgical procedures because it is less invasive, it results in increased radiation exposure due to long fluoroscopy times and the need for frequent imaging. Nurses engaged in cardiac IVR receive the highest lens radiation doses among medical workers, after physicians. Hence, it is important to measure the lens exposure of IVR nurses accurately. Very few studies have evaluated IVR nurse lens doses using direct dosimeters. This study was conducted using direct eye dosimeters to determine the occupational eye dose of nurses engaged in cardiac IVR, and to identify simple and accurate methods to evaluate the lens dose received by nurses. Over 6 months, in a catheterization laboratory, we measured the occupational dose to the eyes (3 mm dose equivalent) and neck (0.07 mm dose equivalent) of nurses on the right and left sides. We investigated the relationship between lens and neck doses, and found a significant correlation. Hence, it may be possible to estimate the lens dose from the neck badge dose. We also evaluated the appropriate position (left or right) of eye dosimeters for IVR nurses. Although there was little difference between the mean doses to the right and left eyes, that to the right eye was slightly higher. In addition, we investigated whether it is possible to estimate doses received by IVR nurses from patient dose parameters. There were significant correlations between the measured doses to the neck and lens, and the patient dose parameters (fluoroscopy time and air kerma), implying that these parameters could be used to estimate the lens dose. However, it may be difficult to determine the lens dose of IVR nurses accurately from neck badges or patient dose parameters because of variation in the behaviors of nurses and the procedure type. Therefore, neck doses and patient dose parameters do not correlate well with the radiation eye doses of individual IVR nurses measured by personal eye dosimeters. For IVR nurses with higher eye doses, more accurate measurement of the radiation doses is required. We recommend that a lens dosimeter be worn near the eyes to measure the lens dose to IVR nurses accurately, especially those exposed to relatively high doses.
... A menudo, los síntomas de incomodidad experimentados por los cirujanos son ignorados, lo que puede disminuir su productividad y poner en peligro su carrera (Knuttinen et al., 2021). En el caso particular de los cirujanos especialistas intervencionistas (EI), que son aquellos que realizan procedimientos terapéuticos con técnicas mínimamente invasivas, guiadas por imágenes diagnósticas, la falta de principios ergonómicos específicamente para cardiólogos y neuro radiólogos, contribuye a trastornos que pueden afectar su calidad de vida, productividad y medios de vida (Cornelis et al., 2021;Shinohara, 2015) ya que estos profesionales, presentan trastornos musculoesqueléticos relacionados con el trabajo (Benjamin & Meisinger, 2018), sin embargo, las prácticas ergonómicas y los entornos de trabajo de ellos, no han sido ampliamente evaluados, lo que los expone a un mayor riesgo de lesiones relacionadas con el trabajo (Cornelis et al., 2021;Knuttinen et al., 2021). Benjamin y Meisinger (2018), utilizaron el cuestionario nórdico (NMQ) para determinar las áreas comúnmente afectadas por problemas musculoesqueléticos relacionados con el trabajo entre los médicos. ...
... A menudo, los síntomas de incomodidad experimentados por los cirujanos son ignorados, lo que puede disminuir su productividad y poner en peligro su carrera (Knuttinen et al., 2021). En el caso particular de los cirujanos especialistas intervencionistas (EI), que son aquellos que realizan procedimientos terapéuticos con técnicas mínimamente invasivas, guiadas por imágenes diagnósticas, la falta de principios ergonómicos específicamente para cardiólogos y neuro radiólogos, contribuye a trastornos que pueden afectar su calidad de vida, productividad y medios de vida (Cornelis et al., 2021;Shinohara, 2015) ya que estos profesionales, presentan trastornos musculoesqueléticos relacionados con el trabajo (Benjamin & Meisinger, 2018), sin embargo, las prácticas ergonómicas y los entornos de trabajo de ellos, no han sido ampliamente evaluados, lo que los expone a un mayor riesgo de lesiones relacionadas con el trabajo (Cornelis et al., 2021;Knuttinen et al., 2021). Benjamin y Meisinger (2018), utilizaron el cuestionario nórdico (NMQ) para determinar las áreas comúnmente afectadas por problemas musculoesqueléticos relacionados con el trabajo entre los médicos. ...
... Aunque la edad y la exposición acumulada al estrés laboral son factores de riesgo para el desarrollo de estos problemas, hasta el 80% de los médicos más jóvenes también pueden experimentar este problema, lo que podría atribuirse a su limitada experiencia y habilidades operativas (Knuttinen et al., 2021). Sin embargo, es posible que exista un sesgo hacia la falta de información sobre la incomodidad debido a la cultura general, donde solo los cirujanos con prácticas y/o condiciones más saludables continúan operando (Cornelis et al., 2021). ...
en: Los profesionales que realizan intervenciones médicas corren el riesgo de sufrir trastornos musculoesqueléticos relacionados con el trabajo. Estos riesgos están principalmente asociados con posturas de trabajo inadecuadas, falta de soporte ergonómico durante los procedimientos y el efecto acumulativo del esfuerzo físicorepetido debido al aumento de la carga de trabajo. Este estudio se centra en un dispositivo llamado STARSystem y su impacto en la reducción de riesgos laborales en los campos de cardiología intervencionista y neurorradiología, con especial énfasis en los aspectos posturales. La investigación se divide en dos partes cuantitativa y cualitativa. El enfoque cuantitativo empleó técnicas de baropodometría, oscilografía, cinemática y sistemas de video de alta velocidad. El enfoque cualitativo se basó en encuestasy entrevistas para evaluar el STARSystem desde la perspectiva de los usuarios. Los resultados indican que el STARSystem proporciona una mejor postura para los especialistas, ya que mejora la distribución de carga más equilibrada en los pies, una movilidadmejorada en términos de cantidad y calidad, reducción del estrés muscular, y un equilibrio estático más eficiente. Además, se observó una mejora en la precisión de los procedimientos y una reducción en el tiempo de configuración en comparación con los sistemas tradicionales. Los especialistas mencionan que mejora no solo la postura de ellos sino también la del paciente. En conclusión, el uso adecuado del STARSystem puede ayudar a los profesionales que realizan accesos radiales a mejorar su salud, rendimiento en los procedimientos y prevenir patologías musculoesquelé
... It is crucial to evaluate exposure of patients and healthcare workers to radiation during radiological examinations, especially IVR [47][48][49][50][51][52]. Despite the importance of protecting IVR physicians from occupational radiation exposure, no ideal radiation shield exists [53][54][55][56]. ...
Interventional radiology (IVR) procedures are associated with increased radiation exposure and injury risk. Furthermore, radiation eye injury (i.e., cataract) in IVR staff have also been reported. It is crucial to protect the eyes of IVR physicians from X-ray radiation exposure. Many IVR physicians use protective Pb eyeglasses to reduce occupational eye exposure. However, the shielding effects of Pb eyeglasses are inadequate. We developed a novel shield for the face (including eyes) of IVR physicians. The novel shield consists of a neck and face guard (0.25 mm Pb-equivalent rubber sheet, nonlead protective sheet). The face shield is positioned on the left side of the IVR physician. We assessed the shielding effects of the novel shield using a phantom in the IVR X-ray system; a radiophotoluminescence dosimeter was used to measure the radiation exposure. In this phantom study, the effectiveness of the novel device for protecting against radiation was greater than 80% in almost all measurement situations, including in terms of eye lens exposure. A large amount of scattered radiation reaches the left side of IVR physicians. The novel radiation shield effectively protects the left side of the physician from this scattered radiation. Thus, the device can be used to protect the face and eyes of IVR physicians from occupational radiation exposure. The novel device will be useful for protecting the face (including eyes) of IVR physicians from radiation, and thus could reduce the rate of radiation injury. Based on the positive results of this phantom study, we plan to perform a clinical experiment to further test the utility of this novel radiation shield for IVR physicians.
... The protective aprons increase the risk of musculoskeletal disorders. Careful selection of a personal protective apron is thus important [55,56]. ...
... Possible ergonomic improvements include the use of a two-part protective apron (that separately protects the chest and waist). This would distribute the protective apron weight more equally across the shoulders and waist, possibly reducing the risk of musculoskeletal pain [56]. ...
Radiation protection/evaluation during interventional radiology (IVR) poses a very important problem. Although IVR physicians should wear protective aprons, the IVR physician may not tolerate wearing one for long procedures because protective aprons are generally heavy. In fact, orthopedic problems are increasingly reported in IVR physicians due to the strain of wearing heavy protective aprons during IVR. In recent years, non-Pb protective aprons (lighter weight, composite materials) have been developed. Although non-Pb protective aprons are more expensive than Pb protective aprons, the former aprons weigh less. However, whether the protective performance of non-Pb aprons is sufficient in the IVR clinical setting is unclear. This study compared the ability of non-Pb and Pb protective aprons (0.25- and 0.35-mm Pb-equivalents) to protect physicians from scatter radiation in a clinical setting (IVR, cardiac catheterizations, including percutaneous coronary intervention) using an electric personal dosimeter (EPD). For radiation measurements, physicians wore EPDs: One inside a personal protective apron at the chest, and one outside a personal protective apron at the chest. Physician comfort levels in each apron during procedures were also evaluated. As a result, performance (both the shielding effect (98.5%) and comfort (good)) of the non-Pb 0.35-mm-Pb-equivalent protective apron was good in the clinical setting. The radiation-shielding effects of the non-Pb 0.35-mm and Pb 0.35-mm-Pb-equivalent protective aprons were very similar. Therefore, non-Pb 0.35-mm Pb-equivalent protective aprons may be more suitable for providing radiation protection for IVR physicians because the shielding effect and comfort are both good in the clinical IVR setting. As non-Pb protective aprons are nontoxic and weigh less than Pb protective aprons, non-Pb protective aprons will be the preferred type for radiation protection of IVR staff, especially physicians.
... calculated in this study were lower to the reference strandards required by the European Directive 2013/59/Euratom in interventional radiology for a vertebroplasty in 1 level (KAP: 60 Gy.cm 2 , AK: 610 mGy and FT: 9 min) or 3 or more levels (110 Gy.cm 2 , 1160 mGy and 14 min) [16,17]. While further studies are needed to validate these results, the use of such intravertebral implants may further help to standardize the procedures without increasing dosage [18]. ...
Background and objectives: Cancer-related vertebral compression fractures (VCF) may cause debilitating back pain and instability, affecting the quality of life of cancer patients. To further drive cement deposition during vertebroplasty, the aims of this restrospective case series study were to report the feasibility, safety and short term efficacy (≤6 months) of percutaneous vertebral fixation in cancer-related vertebral compression fractures using various intravertebral implants. Methods: All consecutive cancer patients treated with percutaneous vertebral fixation for VCF were retrospectively included. Various devices were inserted percutaneously under image guidance and filled by cement. Descriptive statistics were used and a matched paired analysis of pain scores was performed to assess for changes following interventions. Results: A total of 18 consecutive patients (12 women (66.6%) and 6 men (33.3%); mean age 59.7 ± 15.5 years) were included. A total of 42 devices were inserted in 8 thoracic and 16 lumbar vertebrae. Visual analogue scale measurement significantly improved from 5.6 ± 1.8 preoperatively to 1.5 ± 1.7 at 1 week (p < 0.01) and to 1.5 ± 1.3 at 6 months (p < 0.01). No severe adverse events were observed, but three adjacent fractures occurred between 1 week and 5 months after implantation. Conclusions: Percutaneous vertebral fixation of cancer-related VCF is feasible and safe and allows pain relief.
Increasing numbers of medical specialists are performing fluoroscopy-guided interventional procedures (FGIPs). In 2016, approximately one in every 12 inpatients in the United States underwent at least one interventional radiology (IR) procedure during their hospitalization. The use of medical ionizing radiation in the USA was reported sevenfold higher in 2006 compared to 1980, when the amount due to FGIP increased 33 times. The new international recommendations on radiation safety have led to national and international efforts to promote patient and staff radiation safety. Basic understanding of radiation safety principles in daily practice is a key to safe interventional radiology practice. This chapter will review the basic principles of radiation protection, the basis of biological effects of ionizing radiation, and new technologies aimed at dose reduction for staff and patients.
Protection against occupational radiation exposure in clinical settings is important. This paper clarifies the present status of medical occupational exposure protection and possible additional safety measures. Radiation injuries, such as cataracts, have been reported in physicians and staff who perform interventional radiology (IVR), thus, it is important that they use shielding devices (e.g., lead glasses and ceiling-suspended shields). Currently, there is no single perfect radiation shield; combinations of radiation shields are required. Radiological medical workers must be appropriately educated in terms of reducing radiation exposure among both patients and staff. They also need to be aware of the various methods available for estimating/reducing patient dose and occupational exposure. When the optimizing the dose to the patient, such as eliminating a patient dose that is higher than necessary, is applied, exposure of radiological medical workers also decreases without any loss of diagnostic benefit. Thus, decreasing the patient dose also reduces occupational exposure. We propose a novel four-point policy for protecting medical staff from radiation: patient dose Optimization, Distance, Shielding, and Time (pdO-DST). Patient dose optimization means that the patient never receives a higher dose than is necessary, which also reduces the dose received by the staff. The patient dose must be optimized: shielding is critical, but it is only one component of protection from radiation used in medical procedures. Here, we review the radiation protection/reduction basics for radiological medical workers, especially for IVR staff.
