10 May Survey Puts Spotlight on Physical Stress of Working in a Cath Lab
Cath lab personnel who spend long hours wearing heavy lead aprons to protect against radiation exposure are more likely to experience musculoskeletal problems than colleagues who work in other hospital settings, according to the results of a survey published in the March 3, 2015, issue of the Journal of the American College of Cardiology. Cath lab staffers did not report more radiation-related cataracts and cancers, although the low prevalence of such conditions and the study’s cross-sectional design may have hampered its ability to detect a difference.
According to an accompanying editorial by James A. Goldstein, MD, of the Beaumont Health System (Royal Oak, MI), years of such physical stress can result in “missed days of work, surgery, and, in some cases, curtailed careers.”
Investigators led by Mandeep Singh, MD, of the Mayo Clinic (Rochester, MN), emailed surveys to 2,682 cardiology and radiology department employees at 6 Mayo Clinic facilities across the country and received responses from 57% (n = 554 in cardiology and 989 in radiology; average age 43 years; 33% male). Respondents were divided into cath lab workers (n = 1,042) and controls (n = 499) based on whether they reported being engaged in procedures involving radiation.
The most common occupations of respondents were:
Technician/technologist: 54.3% (mean 15.5 years in position)
Registered nurse: 18.3% (mean 16.1 years)
Physician: 13.4% (mean 18.8 years)
Other: 9.3% (mean 11.3 years)
Resident/fellow: 4.7% (mean 4.0 years)
Clinical employees with exposure to procedures involving radiation that required wearing a lead apron were more likely to have experienced work-related pain and to have sought medical care for it than the control group. In addition, they were more likely to report pain at the time of the survey (table 1).
However, there was no difference between the groups in objective assessment scores for current pain, recent use of pain medication, missed workdays, or use of disability.
The association between work-related pain and lead apron wearing remained after adjustment for age, sex, body mass index, preexisting musculoskeletal conditions, years in the profession, and job description (adjusted OR 1.67; 95% CI 1.32-2.11).
Cath lab employees who reported a history of work-related pain were more likely to be female, spent more time each week exposed to radiation, and wore a lead apron more often than controls (all P < .001). Tactics aimed at reducing musculoskeletal pain were also more common in those who reported work-related pain and included:
Prompt removal of the lead apron after procedures
Stretching/exercising before or after procedures
Wearing soft-soled shoes
There was no relationship between risk of injury and the type of lead apron worn (1 piece vs 2 pieces) or use of a glass shield or eye protection.
The likelihood of experiencing work-related pain varied by job description, with the highest incidence reported by techs (62%) and nurses (60%), followed by attending physicians (44%) and trainees (19%; P for trend < .001). Although techs and nurses were more likely than attending physicians to be female, the findings were similar when the analysis was restricted to men or women.
Cath lab workers exposed to radiation did not report more cancers, cataracts, hypothyroidism, or nephrolithiasis than employees not so exposed and showed no difference in rates of a composite endpoint including these conditions and musculoskeletal pain (P = .26).
Focus on Relieving Physical Stress
According to the authors, this is the first study to show that techs and nurses have a higher prevalence of work-related musculoskeletal pain than attending physicians despite being younger and having fewer years in the cath lab.
One reason for the discrepancy may be that physicians regularly rotate out of the cath lab while nurses and tech personnel do not, they suggest. Another possible contributor is that staff perform physically stressful tasks, like transferring patients on and off the table and applying compression after sheath removal.
According to Dr. Singh and colleagues, ongoing efforts should be made to provide regular ergonomic evaluations, periodic rotations out of the cath lab suite, and lighter-weight, non–lead-based protective wear. In addition, they say, robotic interventional equipment and remote monitoring technologies may help reduce both the number of personnel needed to care for the patient and their proximity to the radiation source, thereby diminishing the time spent wearing a lead apron.
The researchers acknowledge that these data cannot resolve questions about cancer risk from radiation exposure, in part because the incidence of the disease in younger cath lab personnel is low. Moreover, staffers diagnosed with cancer may transfer to a job that does not expose them to radiation or retire, and thus their cases would not be captured in this cross-sectional survey.
In the editorial, Dr. Goldstein calls the findings “alarming and sobering.” But, he adds, given the growth in the volume, complexity, and length of interventional procedures, the “escalating epidemic of occupational-induced orthopedic afflictions” should not be surprising. Dr. Goldstein observes that innovative equipment that facilitate quality imaging with lower doses is helping to minimize radiation exposure, and measures like ceiling-suspended lead aprons, shielded gloves and scrub caps for cranial protection, and vascular robotic technology can help reduce orthopedic problems.
‘Take Care of Yourself’
But in a telephone interview with TCTMD, Craig St. George, RT, director of online education for the American Society of Radiologic Technologists (Albuquerque, NM), said that over 6 years working at the Mayo Clinic in Jacksonville, FL, he cannot recall anyone complaining of a work-related injury. However, he noted, many of his colleagues exercised, stretched, and practiced yoga, which likely helped counter the stress of wearing a lead apron day after day. Another important factor in minimizing aches and pains, he suggested, was that each person was custom-fitted for an apron. And they could choose from different versions, including a wraparound model with a waist belt that took much of the weight off the shoulders. They also stood on ergonomic pads near the table to help cushion their feet during long hours. In addition, the strain of transferring patients to and from the table was mitigated by working in teams.
As for any radiation concerns, Mr. St. George said he relied on his training—making sure he was properly shielded and standing in the right place to minimize exposure—and oversight by the hospital’s radiation safety officer. “I know people who have been technologists for 20 or 30 years, and I’ve never heard anyone say, ‘This is really wearing on me,’ he commented, adding, “You go into the profession because you want to take care of patients, and to do that you have to take care of yourself.”
Sources: 1. Orme NM, Rihal CS, Gulati R, et al. Occupational health hazards of working in the interventional laboratory: a multisite case control study of physicians and allied staff. J Am Coll Cardiol. 2015;65:820-826. 2. Goldstein JA. Orthopedic afflictions in the interventional laboratory: tales from the working wounded [editorial]. J Am Coll Cardiol. 2015;65:827-829.
Dr. Singh reports no relevant conflicts of interest.
Dr. Goldstein reports owning equity in a company developing radiation shielding equipment.
Mr. St. George reports no relevant conflicts of interest.