Ergonomics in Interventional Radiology: Awareness Is Mandatory

A regression model on work-related musculoskeletal disorders and associated risk factors among radiographers

Objectives. This study aimed to develop a predictive model for work-related musculoskeletal disorders (WRMSDs) among radiographers. Methods. A survey was conducted in seven hospitals in two cities with radiographers using the ergonomic assessment for radiographers questionnaire. Logistic regression, confirmatory factor analysis and structural equation modelling (SEM) were utilized to establish statistical relationships between independent factors and musculoskeletal complaints. Results. Of 165 respondents, 75.2% reported musculoskeletal pain in the past 12 months, with lower back pain the most prevalent (58.8%). Adjusting for covariates, musculoskeletal pain significantly correlated with body mass index < 23 (odds ratio [OR] 0.06, 95% confidence interval [CI] [0.005, 0.914]), smoking status (OR 0.274, 95% CI [0.751, 6.195]), fixed work break schedule (OR 2.839, 95% CI [1.123, 7.176]), sustained posture (OR 4.854, 95% CI [1.203,19.594]) and prolonged standing or walking (OR 7.499, 95% CI [1.086, 51.753]). The fit measures indicate a moderately good fit of the proposed model to the observed data. However, latent variables did not exhibit significant associations with WRMSD in SEM. Conclusions. The model suggests that WRMSDs among radiographers moderately correlate with underweight, smoking status, fixed work breaks, sustained posture and extended periods of standing or walking. The absence of significant associations between latent variables and WRMSDs suggests the presence of unexplored factors influencing the outcome.Trial registration: Clinical Trials Registry India identifier: CTRI/2021/09/036992.

Interventional Oncology: 2024 Update

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.

Wellness Among Interventional Radiologists: Results From a Multidimensional Survey

RATIONALE AND OBJECTIVES

To evaluate wellness among interventional radiologists using a multidimensional survey.

MATERIALS AND METHODS

An anonymous 53-item survey, including 36 Perceived Wellness Survey (PWS) prompts, was created in Qualtrics (an online survey tool) to assess wellness among interventional radiology attendings and residents. The survey was open from June to September, 2022, 2 years into the COVID-19 Pandemic. The survey was distributed via Society of Interventional Radiology Forums, social media (Twitter, LinkedIn, and Facebook), and personal correspondence. PWS scores were categorized into Wellness Composite and subscores (physical, emotional, intellectual, psychological, social, and spiritual).

RESULTS

367 surveys were completed. 300 (81.7%) respondents were male and 67 (18.3%) were female. Respondents included attending physicians (297; 81.0%) and residents (70; 19.0%). Practice settings included academic (174; 47.4%), private (114; 31.0%), private-academic hybrid (62; 16.9%), and others (17; 4.7%). Mean Wellness Composite at academic centers (14.74 ± 3.16; range: 5.42-23.50) was significantly lower than at private (15.22 ± 3.37; range: 6.13-23.51) and hybrid (16.14 ± 2.47; range: 10.20-23.50) practices (p = 0.01). Respondents < 40 years old had significantly lower emotional wellness subscores compared to those ≥ 40 years old (4.34 ± 0.86 vs. 4.60 ± 0.87; p = 0.006). There were no significant differences between geographic regions in the United States, however, International respondents had significantly lower social and intellectual wellness (INT) subscores. Physical wellness subscore (4.00 ± 0.9) was significantly lower than the other subscores (4.59 ± 0.81) (p < .001). Overall mean Wellness Composite was 15.11 ± 3.13 (range: 5.42-23.51).

CONCLUSION

Overall self-reported wellness was lower among interventional radiologists practicing at academic centers. Interventional Radiologists < 40 years old and residents had lower emotional wellness, while international respondents had lower social and INT. Overall wellness scores were lower than prior PWS studies.

Eye Lens Radiation Dose to Nurses during Cardiac Interventional Radiology: An Initial Study

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.

Development of a New Radiation Shield for the Face and Neck of IVR Physicians

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.

What are useful methods to reduce occupational radiation exposure among radiological medical workers, especially for interventional radiology personnel?

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.

Non-Lead Protective Aprons for the Protection of Interventional Radiology Physicians from Radiation Exposure in Clinical Settings: An Initial Study

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.

Percutaneous Image-Guided Vertebral Fixation in Cancer-Related Vertebral Compression Fractures: A Case Series Study

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.