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Radiation Protection & Musculoskeletal Disorders. Mike Betts MSc, RGN Freelance Manual Handling Consultant enquiries@mjbtraining.co.uk. Contributory Factors. Work - Static Postures and long interventions Poor postures – leaning, twisting and a combination Pushing trolleys Lead Aprons
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Radiation Protection & Musculoskeletal Disorders Mike Betts MSc, RGN Freelance Manual Handling Consultant enquiries@mjbtraining.co.uk
Contributory Factors • Work - • Static Postures and long interventions • Poor postures – leaning, twisting and a combination • Pushing trolleys • Lead Aprons • Home – • Leisure activities • Posture • Domestic workload
Epidemiology • 52% of respondents who estimated that their lead apron use was greater than 10 hours per week and 46% of respondents who wore lead aprons for less than 10 hours per week, reported back pain, (Moore et al 1992). • Cardiologists who wore lead aprons, had a significantly higher incidence of skeletal complaints, and more days missed from work, because of back pain, (Pelz 1999, Ross et al, 1997 Goldstein et al 2004). • Association between back, neck and upper extremity musculoskeletal pain and wearing body armour for longer than 4 hrs, (Kanitzer et al 2008)
The Pinkerton “Hang ‘em High” apron support system; B, Wearing the apron system; C, Performing angiography whilst wearing the apron A B C
Types of Radiation Protection, (Aprons) • Full-length lead Radiation Protection, • (approximately 8kg) • Full-length lead replacement apron, • (approximately 5kg) • Two-piece lead replacement aprons, consisting of • skirt and top, (Approximately 5kg. Weight • distribution 60% shoulders, 40% on the hips).
Back Belts • RCN Guidelines – Best Practice Guidance on radiation protection and the use of radiation protective equipment – recommends protective lumbar support belts • Healthsafe recommends support belts amongst other solutions. • Research suggests that there is no evidence that back belts will provide support and reduce the risk of lower back pain, (Wassell et al 2000).
Other solutions • Time limit – Maximum duration of 2 hours with a minimum of 1hr rest period in between. • Definition of a rest period - A rest break is a period where lead aprons are not worn for a minimum of one hour. A rest break may involve other work activities, i.e. Ultrasound or CT scanning etc. and also include refreshment and comfort breaks. • Only put the protection on at the last possible moment and remove as early as possible. • National Guidance
Research • Goldstein JA, Balter S, Cowley M. Occupational hazards of interventional cardiologists: Prevalence of orthopaedic health problems in contemporary practice. Catheter Cardiovascular Interv 2004 Dec; 63(4):407-411. • www.healthsafe.uab.edu/pages/radiationsafety/apronleadpolicyupdated2.pdf • Kanitzer et al (2008). Association between back, neck and upper extremity musculoskeletal pain and the individual body armour.Journal of Hand Therapy 21(2) 143-8 • Moore. B, van Sonnenberg. E, Casola. G, Novelline. RA, (1992). The Relationship between back pain and lead apron use in Radiologists. American Journal of Roentgenology. Vol 158, pp 191-193. • Pelz. D, (1999). Low Back, Lead Aprons, and the angiographer. The Advanced Journal of Neuroradiology. Vol 21. • Ross AM, Segal J, Borenstein D. (1997). Prevalence of spinal disc disease among interventional cardiologists. Am J C Cardiol 1997 Jan 1;79(1):68-70. • Wassell et al (2000). A prospective study of back belts for prevention of back pain and injury. Journal of the American Medical Association. 284 (21) 2727-32 • Zuguchi et al (2008). Usefulness of non-lead aprons for physicians performing interventional procedures. Radiation Protection Dosimetry Vol 131, No.4, 531-34
