Radiation Protection & Musculoskeletal Disorders

Mike Betts MSc, RGNFreelance Manual Handling Consultantenquiries@mjbtraining.co.uk

Contributory Factors

Work - Static Postures and long interventionsPoor postures – leaning, twisting and a combinationPushing trolleys Lead Aprons

Home – Leisure activitiesPostureDomestic 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)

Hierarchy of Controls

The Pinkerton “Hang ‘em High” apron support system; B, Wearing the apron system; C, Performing angiography whilst wearing the apron

A B C

Hierarchy of Controls

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).

Hierarchy of Controls

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