Anti-X Apron Wearing and Musculoskeletal Problems Among Healthcare Workers: A Systematic Scoping Review

The Effect of a Suspended Radiation Protection System on Occupational Radiation Doses During Infrarenal EVAR Procedures: A Randomised Controlled Study

OBJECTIVE

To compare the protective effect of Zero Gravity (ZG) with conventional radiation protection during endovascular aneurysm repair (EVAR). Secondly, user experience was surveyed with a questionnaire on ergonomics.

METHODS

This was a single centre, prospective, randomised, two arm trial where 71 consecutive elective infrarenal EVAR procedures were randomised into two groups: (1) operator using ZG and assistant using conventional protection (n = 36), and (2) operator and assistant using conventional radiation protection (n = 35). A movable floor unit ZG system consists of a lead shield (1.0 mm Pb equivalent) for the front of the body and 0.5 mm Pb equivalent acrylic shielding for the head and neck. The ZG also includes arm flaps of 0.5 mm Pb equivalent covering the arm up to the elbow. Deep dose equivalent values, Hp(10) were measured with direct ion storage dosimeters (DIS) placed on various anatomical regions of the operator (axilla, chest, abdomen, and lower leg). Personal dose equivalent values, Hp(3) to eye lenses were measured in the operating and assisting surgeon using thermoluminescence dosimeters. The study was registered at the US National Institute of Health #NCT04078165.

RESULTS

Protection with the standard protection was superior in chest (0.0 vs. 0.1 μSv), abdomen (0.0 vs. 0.6 μSv), and lower leg (0.4 vs. 2.2 μSv) (p < .001). On the other hand, the ZG system yielded better shielding for the axilla (1.5 vs. 0.0 μSv) and eyes (6.3 vs. 1.1 μSv) of the operator. The use of ZG hampered the deployment of ancillary shields, which is particularly relevant for protection of the assisting surgeon. Users found ZG more cumbersome than conventional garments, it also impaired communication and reduced field of view.

CONCLUSION

Both ZG and conventional radiation protection reduced radiation exposure. Conventional protection allows better manoeuvrability at the price of wider exposure of the upper arm and axilla. ZG indirectly impaired protection of the assistant.

Metal Particle Pencil Beam Spray-Coating Method for High-Density Polymer-Resin Composites: Evaluation of Radiation-Shielding Sheet Properties

Medical shielding suits must be lightweight and satisfy the requirements of thin films to guarantee user mobility and safety. The thin film weight is related to the density and thickness, which are associated with the particle dispersion in shielding materials. An even distribution of metal particles in a polymer can maintain the spacing among them. This paper proposes a pencil beam spray-coating method that involves spraying a constant amount of a polyethylene and tungsten mixture in a thin beam onto a nonwoven fabric at a constant speed. This technique yields higher productivity than does the electrospinning method and is expected to produce materials with better shielding performance than that of materials obtained using the calender method. The shielding performance was evaluated by manufacturing shielding sheets (thickness: 0.48-0.54 mm) using the calender and pencil beam spray-coating methods under the same conditions. The densities and performances of the sheets differed significantly. The sheet manufactured using the proposed method had an even particle dispersion and exhibited 2-4% better shielding performance than did that manufactured using the calender method. Therefore, the pencil beam spray-coating method can effectively satisfy the requirements of thin films for medical radiation-shielding materials while increasing the material flexibility.

Electroanatomical Mapping System-Guided vs. Intracardiac Echocardiography-Guided Slow Pathway Ablation: A Randomized, Single-Center Trial

Radiofrequency (RF) catheter ablation is an effective treatment option for targeting the slow pathway (SP) in atrioventricular nodal reentry tachycardia (AVNRT). Previous data suggested that using intracardiac echocardiography (ICE) guidance could improve procedural outcomes when compared to using fluoroscopy alone. In this prospective study, we aimed to compare the effectiveness of an electroanatomical mapping system (EAMS)-guided approach with an ICE-guided approach for SP ablation. Eighty patients undergoing SP ablation for AVNRT were randomly assigned to either the ICE-guided or EAMS-guided group. If the procedural endpoint was not achieved after 8 RF applications; patients were allowed to crossover to the ICE-guided group. The ICE-guided approach reduced the total procedure time (61.0 (56.0; 66.8) min vs. 71.5 (61.0; 80.8) min, p < 0.01). However, the total fluoroscopy time was shorter (0 (0-0) s vs. 83.5 (58.5-133.25) s, p < 0.001) and the radiation dose was lower (0 (0-0) mGy vs. 3.3 (2.0-4.7) mGy, p < 0.001) with EAMS-guidance. The ICE-guided group had a lower number of RF applications (4 (3-5) vs. 5 (3.0-7.8), p = 0.03) and total ablation time (98.5 (66.8-186) s vs. 136.5 (100.5-215.8) s, p = 0.02). Nine out of 40 patients (22.5%) in the EAMS-guided group crossed over to the ICE-guided group, and they were successfully treated with similar RF applications in terms of number, time, and energy compared to the ICE-guided group. There were no recurrences during the follow-up period. In conclusion, the utilization of ICE guidance during SP ablation has demonstrated notable reductions in procedural time and RF delivery when compared to procedures guided by EAMS. In challenging cases, an early switch to ICE-guided ablation may be the optimal choice for achieving successful treatment.

Operator Intracranial Dose Protection During Fluoroscopic-Guided Interventions

PURPOSE

We utilized an anthropomorphic model made with a human skull to determine how different personal protective equipment influence operator intracranial radiation absorbed dose.

MATERIALS AND METHODS

A custom anthropomorphic phantom made with a human skull coated with polyurethane rubber, mimicking superficial tissues, and was mounted onto a plastic thorax. To simulate scatter, an acrylic plastic scatter phantom was placed onto the fluoroscopic table with a 1.5 mm lead apron on top. Two Radcal radiation detectors were utilized; one inside of the skull and a second outside. Fluoroscopic exposures were performed with and without radiation protective equipment in AP, 45-degree RAO, and 45-degree LAO projections.

RESULTS

The skull and soft tissues reduce intracranial radiation by 76% when compared to radiation outside the skull. LAO (308.95 μSv/min) and RAO projections (96.47μSv/min) result in significantly higher radiation exposure to the primary operator when compared to an AP projection (54 μSv/min). All tested radiation protection equipment demonstrated various reduction in intracranial radiation when compared to no protection. The hood (68% reduction in AP, 91% LAO, and 43% in RAO), full cover (53% reduction in AP, 76% in LAO, and 54% in RAO), and open top with ear coverage (43% reduction in AP, 77% reduction in LAO, and 22% in RAO) demonstrated the most reduction in intracranial radiation when compared to the control.

CONCLUSION

All tested equipment provided various degrees of additional intracranial protection. The skull and soft tissues attenuate a portion of intracranial radiation.

Musculoskeletal disorders in interventional radiology workers: an integrative review

This integrative review analyzed scientific production on musculoskeletal disorders related to personal protective equipment used by interventional radiology teams. The PubMed, Embase, and SciELO databases were searched using a strategy developed with the help of a librarian. The double-blind selection process involved the Rayyan online tool. A total of 12 articles were included, which were organized according to year of publication, country research subjects, study type, and main outcomes. Five thematic categories emerged from the analysis: "personal protective equipment"; "ergonomics in the interventional radiology environment"; "the composition of personal protective equipment"; "radiation protection for interventional teams" and "the prevalence of musculoskeletal symptoms in interventional teams". Outcomes associated with musculoskeletal disorders among interventional teams predominated in the studies, and advances in radiological protection were reported, especially in shielding technologies, as well as continuing efforts toward more ergonomic protective equipment to reduce the risk of musculoskeletal disorders.

A First-in-Human Complete Insertion of Single-Chamber Cardiac Pacemaker Using Ultrasound

Pacemaker insertion incurs significant costs for fluoroscopy machines and operator-related musculoskeletal injuries from long-term use of radiation protection equipment. Moreover, there are small potential risks to patients from pneumothorax, lead dislodgment, and cardiac perforation. We report a first-in-human case report of successful pacemaker insertion performed entirely with ultrasound. (Level of Difficulty: Advanced.).

Comparison of Shielding Material Dispersion Characteristics and Shielding Efficiency for Manufacturing Medical X-ray Shielding Barriers

During medical diagnoses, X-ray shielding barriers are used to protect against direct and indirect X-rays. Currently, lead is used as the primary material for shielding barriers; however, the demand for eco-friendly shielding barriers has been increasing. Conventionally, shielding barriers are manufactured using a mechanically bonded combination of lead and aluminum; however, in this study, a plastic-based injection-molded product was developed using tungsten as an eco-friendly alternative to lead. A new process technology was required for mixing tungsten-which can be difficult to process-with a polymer. Consequently, the mixing conditions within the injection molding machine and the related compounding technology factors were analyzed. The process technology considered the pre-mixing method using powdery polymer, particle dispersion method, number of screw rotations, and amount of filler input. The product's shielding performance was then analyzed. The tungsten content of the 2-mm thick barrier manufactured using the proposed method was 90 wt%, and the lead equivalent was 0.321 mmPb. To increase the effectiveness of injection molding in the manufacturing process, specific hourly compounding conditions were proposed. Consequently, the process technology method developed in this study can be considered suitable for manufacturing various shielding barriers.

Cutting Staff Radiation Exposure and Improving Freedom of Motion during CT Interventions: Comparison of a Novel Workflow Utilizing a Radiation Protection Cabin versus Two Conventional Workflows

This study aimed to evaluate the radiation exposure to the radiologist and the procedure time of prospectively matched CT interventions implementing three different workflows—the radiologist—(I) leaving the CT room during scanning; (II) wearing a lead apron and staying in the CT room; (III) staying in the CT room in a prototype radiation protection cabin without lead apron while utilizing a wireless remote control and a tablet. We prospectively evaluated the radiologist’s radiation exposure utilizing an electronic personal dosimeter, the intervention time, and success in CT interventions matched to the three different workflows. We compared the interventional success, the patient’s dose of the interventional scans in each workflow (total mAs and total DLP), the radiologist’s personal dose (in µSV), and interventional time. To perform workflow III, a prototype of a radiation protection cabin, with 3 mm lead equivalent walls and a foot switch to operate the doors, was built in the CT examination room. Radiation exposure during the maximum tube output at 120 kV was measured by the local admission officials inside the cabin at the same level as in the technician’s control room (below 0.5 μSv/h and 1 mSv/y). Further, to utilize the full potential of this novel workflow, a sterile packed remote control (to move the CT table and to trigger the radiation) and a sterile packed tablet anchored on the CT table (to plan and navigate during the CT intervention) were operated by the radiologist. There were 18 interventions performed in workflow I, 16 in workflow II, and 27 in workflow III. There were no significant differences in the intervention time (workflow I: 23 min ± 12, workflow II: 20 min ± 8, and workflow III: 21 min ± 10, p = 0.71) and the patient’s dose (total DLP, p = 0.14). However, the personal dosimeter registered 0.17 ± 0.22 µSv for workflow II, while I and III both documented 0 µSv, displaying significant difference (p < 0.001). All workflows were performed completely and successfully in all cases. The new workflow has the potential to reduce interventional CT radiologists’ radiation dose to zero while relieving them from working in a lead apron all day.

Ergonomics in Interventional Radiology: Awareness Is Mandatory

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 their livelihoods, quality of life, and productivity. The objectives of this review were to describe the different situations encountered in interventional radiology and to compile the strategies both available to date and in development to improve ergonomics.

Analysis of Shielding Performance of Radiation-Shielding Materials According to Particle Size and Clustering Effects

In the field of medical radiation shielding, there is an extensive body of research on process technologies for ecofriendly shielding materials that could replace lead. In particular, the particle size and arrangement of the shielding material when blended with a polymer material affect shielding performance. In this study, we observed how the particle size of the shielding material affects shielding performance. Performance and particle structure were observed for every shielding sheet, which were fabricated by mixing microparticles and nanoparticles with a polymer material using the same process. We observed that the smaller the particle size was, the higher both the clustering and shielding effects in the high-energy region. Thus, shielding performance can be improved. In the low-dose region, the effect of particle size on shielding performance was insignificant. Moreover, the shielding sheet in which nanoparticles and microsized particles were mixed showed similar performance to that of the shielding sheet containing only microsized particles. Findings indicate that, when fabricating a shielding sheet using a polymer material, the smaller the particles in the high-energy region are, the better the shielding performance is. However, in the low-energy region, the effect of the particles is insignificant.