1. Radiation Protection & Musculoskeletal Disorders Mike Betts MSc, RGN Freelance Manual Handling Consultant enquiries@mjbtraining.co.uk

2. Contributory Factors  Work -  Static Postures and long interventions  Poor postures – leaning, twisting and a combination  Pushing trolleys  Lead Aprons  Home –  Leisure activities  Posture  Domestic workload

3. 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)

4. Hierarchy of Controls Eliminate the Hazard Remove it completely from the workplace Substitute the Hazard With a safer alternative Use Personal Protective Equipment Back Belts

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

6. Hierarchy of Controls Eliminate the Hazard Remove it completely from the workplace Substitute the Hazard With a safer alternative Use Personal Protective Equipment Back Belts

7. 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).

8. Hierarchy of Controls Eliminate the Hazard Remove it completely from the workplace Substitute the Hazard With a safer alternative Use Personal Protective Equipment Back Belts

9.  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).

10. 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

12. 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