Get the Lead off Our Backs! Chet R. Rees, MD, Barrett W.C. Duncan, MD  Techniques in Vascular & Interventional Radiology  Volume 21, Issue 1, Pages 7-15 (March 2018) DOI: 10.1053/j.tvir.2017.12.003 Copyright © 2018 Elsevier Inc. Terms and Conditions

Figure 1 Interventional cardiologists were more often treated for spine pain, were much more likely to herniate a cervical disc, and were the only group to experience multilevel disease (A). Interventional cardiologists missed more days of work and were more likely to alter their practices (terminate performance of procedures) due to spine disease (B). Compared to nonusers of aprons, apron users were more often treated for spine disease, were more likely to herniate a cervical disc or experience multilevel disease, and missed more days of work due to back pain or sciatica (C). Techniques in Vascular & Interventional Radiology 2018 21, 7-15DOI: (10.1053/j.tvir.2017.12.003) Copyright © 2018 Elsevier Inc. Terms and Conditions

Figure 2 EP cardiologists had more spine problems than noninterventional cardiologists and were the only group to include physicians with both lumbar and cervical diseases. Techniques in Vascular & Interventional Radiology 2018 21, 7-15DOI: (10.1053/j.tvir.2017.12.003) Copyright © 2018 Elsevier Inc. Terms and Conditions

Figure 3 The SPRPS is suspended from overhead, providing a weightless shield covering a large portion of the body (A). It remains in contact with the operator’s body through sterile layers by use of a magnetic attachment between a lightweight vest worn by the operator and the device (B). The quick-release attachment engages when the operator steps into the device, and it is disengaged by pushing the device away with the hands. It is important to adjust the chest level so that SPRPS rides as high as comfortable to provide best protection for eyes and head. Several types of overhead suspension systems are available for all room configurations including a ceiling mounted monorail system (C) and a mobile floor unit (D). (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2018 21, 7-15DOI: (10.1053/j.tvir.2017.12.003) Copyright © 2018 Elsevier Inc. Terms and Conditions

Figure 4 Transmission through different thickness of lead sheets shows an exponential decrease in transmission rate as the thickness increases. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2018 21, 7-15DOI: (10.1053/j.tvir.2017.12.003) Copyright © 2018 Elsevier Inc. Terms and Conditions

Figure 5 The armhole of a standard apron is a sizable window to the deep tissues of the torso and neck. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2018 21, 7-15DOI: (10.1053/j.tvir.2017.12.003) Copyright © 2018 Elsevier Inc. Terms and Conditions

Figure 6 Face and head shield is positioned at front and sides in the path of the scatter, which is predominantly upwardly directed, while allowing free line-of-sight to the monitor over the top of the shield. Shield top may be lower than eyes and yield maximum protection. Reprinted from Savage et al13 with permission by author. Copyright Scientific Research Publishing. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2018 21, 7-15DOI: (10.1053/j.tvir.2017.12.003) Copyright © 2018 Elsevier Inc. Terms and Conditions

Figure 7 An example of a highly effective setup for reduction of exposures to all personnel. During fluoroscopy (A), primary operator (“1”) uses Zero-Gravity (1mm Pb, “ZG”) or lead-containing apron (≥0.5mm) and properly positions the mobile shield (“MS”) when possible. Secondary operator or assistant (“2”) wears lead-containing apron (≥0.5mm) and steps back when possible to get extra shielding from primary operator. Technologist spends most of fluoroscopy time behind the shielded wall or window, where “lightweight” closed-back apron may suffice for occasional circulation. During serial image acquisition (B), primary (“1”) and secondary (“2”) operators move behind wall. The nurse (N) stands behind a floor-mounted shield (FS) as much as possible and wears a wrap-around lead-containing apron. Techniques in Vascular & Interventional Radiology 2018 21, 7-15DOI: (10.1053/j.tvir.2017.12.003) Copyright © 2018 Elsevier Inc. Terms and Conditions

Figure 8 Under-table shield, side-table shield, and mobile suspended lead-acrylic shield are standard recommendations for busy interventionalists. The use of adjunctive shielding while using SPRPS may not be as important. Reprinted from Savage et al13 with permission by author. Copyright Scientific Research Publishing. Techniques in Vascular & Interventional Radiology 2018 21, 7-15DOI: (10.1053/j.tvir.2017.12.003) Copyright © 2018 Elsevier Inc. Terms and Conditions

Figure 9 Mobile floor-supported shield positioned during “CT fluoroscopic” biopsy. Floor-supported shields such as this one are both convenient and effective in substantially reducing exposure to the entire body of personnel not in direct contact with the patient. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2018 21, 7-15DOI: (10.1053/j.tvir.2017.12.003) Copyright © 2018 Elsevier Inc. Terms and Conditions