Physical strain while wearing personal radiation protection systems in interventional radiology

Efficiency in radiation protection of a novel exoskeleton-based interventional radiology apron and correlation with conventional aprons

PURPOSE

In interventional radiology (IR), safeguarding against ionizing radiation is imperative. This study evaluates the comparison of a lead-free exoskeleton-mounted radiation protection apron with an integrated head visor with conventional radiation protection aprons of varied materials. The goal is to contribute insights into optimizing safety for healthcare professionals and patients during IR procedures.

METHODS

The phantom study incorporates a variety of radiation protection aprons: an exoskeleton-mounted lead-free apron with an integrated head visor, a conventional lead apron, a lead- free and a lead-composite apron. The examiner assumed three common working positions (30° left, 0° center, 30° right) during a simulated intervention. A volume tomography cone beam protocol (CBCT) ensured a consistent spectrum of radiation energy. Real-time dosimeters were placed at the eyes, the left axilla, and the pelvis.

RESULTS

The exoskeleton-mounted apron with the integrated head visor demonstrated an average dose reduction of 93.4 % (p < 0.001), outperforming other aprons with shielding capacities only up to 66 % (p < 0.001). The other aprons were deliberately chosen without eye shielding. In the pelvic region, the exoskeleton-mounted apron achieved a 99 % (p < 0.001) dose reduction, with the lead-free apron providing 96 % (p < 0.001) shielding efficacy, and the conventional lead and lead-composite aprons achieving 94 % (p < 0.001) and 90.3 % (p < 0.001), respectively. However, the exoskeleton-mounted apron exhibited a lower dose reduction of 81.3 % (p < 0.001) in the left axilla compared to conventional aprons.

CONCLUSIONS

The evaluated exoskeleton system demonstrated excellent eye protection through its circumferential head visor and notable reduction in the pelvic dose. However, despite these advantages, the exoskeleton did exhibit a particular deficit in the left axilla in our experimental setup. This research emphasizes the potential of innovative radiation protection solutions while highlighting specific areas that require further improvement.

Influence of radiation personal protection equipment design on surgeon stress-A randomised repeated-measures crossover study

INTRODUCTION

Radiation Personal Protective Equipment (RPPE) is the subject of safety guidance from the British Orthopaedic Association (BOA). This pilot study aimed to examine potential performance differences in Trauma and Orthopaedic (T&O) Higher Surgical Trainees (HST) undertaking simulated Dynamic Hip Screw (DHS) surgery related to different RPPE attire.

METHODS

Fourteen Higher Surgical Trainees took part in a randomised, repeated-measures, crossover study (8 male, 6 female HSTs) performing two simulated DHS procedures wearing two RPPE attire styles (One Piece (OP) tabard 0.35 mm thickness, and Two-Piece skirt/top (TP), with a 0.5 mm thyroid guard). Primary outcome measures included continuous Heart Rate (HR) monitoring, body temperature, and Visual Analogue Scales (VAS) for comfort and fatigue before and after simulations.

RESULTS

Mean (SD) HR in OP and TP were HR OP 98.8 bpm (10.3) vs. TP 98.1 bpm (10.8, p < 0.001), Maximum HR OP 115.1 bpm (SD 12.4) vs. TP 113.4 bpm (SD 11.9) (p < 0.001). Mean change in temperature were OP 0°C and TP -0.03 °C (p < 0.001). Mean temperature VAS scores in OP were 1.9 (1.7) vs. TP 2.0 (1.4, p < 0.001). Mean Comfort VAS scores were OP 3.1 (2.4) vs. TP 1.7 (2.1, p < 0.001) and Fatigue OP 1.4 (1.9) vs. TP 0.8 (1.5, p = 0.120).

DISCUSSION

Important differences in surgeon physiological measures (HR, temperature) and self-reported measures of comfort and temperature were found related to RPPE style. Understanding the effects that specific RPPE attire has on performance should influence RPPE choice and the findings help inform future research into this important topic.

Occupational orthopedic problems and its relation to personal radiation protection in interventional radiology

PURPOSE

Several studies report occupational orthopedic problems among interventional cardiologists. These health problems are usually multifactorial. However, the personal protective equipment used should play a major role. An online survey was conducted to determine the frequency of such health problems among interventional radiologists and to correlate them with the use of personal radiation protective clothing.

MATERIAL AND METHODS

An anonymous online survey that comprised of 17 questions was sent via e-mail to 1427 members of the German Society for Interventional Radiology (DeGIR) in Germany, Austria and Switzerland. The questions were focused on interventional workload, the use of personal radiation protection apparel and orthopedic problems. Given the different scale levels, the associations between the variables were analyzed using different statistical methods. A significance level of p < 0.05 was chosen.

RESULTS

There were 221 survey responders (15.5% response rate). About half of responders (47.7%) suffered from more than five episodes of orthopedic problems during their interventional career. Lumbar spine was involved in 81.7% of these cases, cervical spine in 32.8%, shoulder in 28.5% and knee in 24.7%. Because of orthopedic problems, 16.1% of the responders had to reduce and 2.7% had to stop their interventional practice. The number of affected body regions correlates with the fit of the radiation protection means (p < 0.05, r = 0.135) and the reduction of activity as an interventional radiologist (p < 0.05, r = -0.148).

CONCLUSION

Overall, the survey reveals widespread orthopedic problems at several body regions among interventional radiologists, associated with the fit of radiation protection systems, among other factors. A connection between the orthopaedic complaints and the radiation protection system used could not be established.

Comparison of the radiation protection effect of different radiation protection aprons made of different materials

OBJECTIVE

The objective of this study is to examine the performance of new generation protection aprons as alternative to conventional lead aprons regarding their radiation protection effectiveness.

METHOD AND MATERIALS

Radiation protection aprons made of lead-containing and lead-free materials from a total of seven companies were compared. Furthermore, different lead equivalent values of 0.25, 0.35 and 0.5 mm were compared. For quantitative assessment, radiation attenuation was determined with increasing voltage in steps of 20 kV from 70 kV up to 130 kV.

RESULTS

New generation aprons and conventional protection lead aprons showed a similar shielding performance at lower tube voltages below 90 kVp. When tube voltage was increased above 90 kVp, significant (p < 0.05) differences between the three apron types were observed, with conventional lead material as best shielding performer over lead composite and lead-free aprons.

CONCLUSION

We observed a similar radiation protection performance between conventional lead aprons and new generation aprons at low intensity radiation workplaces, with lead aprons being dominant for all energies. Only new generation aprons of 0.5 mm thickness would adequately replace 0.25 and 0.35 mm conventional lead aprons. For healthy radiation protection, the possibility of using weight-reduced X-ray aprons is very limited.