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It’s time to ditch the lead apron

Lead aprons for interventionalists have been around for 100 years or so. You’d think that hospitals and medical facilities would be passionate advocates for changing the status quo and seeking a technology solution alternative, rather than risk their employees’ health and safety, potential workers compensation claims and hikes to their insurance premiums. Sadly, the voices agitating for change have been all too quiet. That is beginning to change. 

In October 2019, in what may be the first lawsuits of their kind, 3 US surgeons filed lawsuits alleging a hospital’s radiation safety practices were inadequate and that radiation exposure caused their cancers. 

All three vascular surgeons started working at St. Vincent Evansville Hospital around 2007 and were diagnosed eight years later within 13 months of each other. Two w/ thyroid cancer and third a left sided glioblastoma. Within six months of diagnosis, Dr. Chris Haughn succumbed to brain cancer.

The lawsuits allege the hospital was negligent in maintaining personal protective equipment, ignored complaints about it and not enough protections were available, including the leaded skirts, jackets, aprons and thyroid shields.

The outcome of the lawsuits is unknown to us at this stage however, given the potential risks to interventionalists this could be a sign of things to come. 

The effects of radiation exposure

For decades, interventionalists and their team have relied on heavy lead aprons to protect themselves from radiation. Aprons only offer partial protection, and over time, their weight takes a physical toll, causing everything from fatigue to serious, career-shortening injuries. 

Interventional physicians have the highest radiation exposure level of all professions (nearly 3 times that of a nuclear power plant worker) and corresponding to a whole body dose equivalent of 2500 to 10 000 chest x-rays with a projected professional lifetime attributable excess cancer risk of 1 in 100 . Cath lab teams, including nurses, spend as much time in the lab (or even more) than the physicians. They require consideration when looking at the long-term effects of radiation and wearing heavy lead. 

To put it in further perspective, Cath Lab teams suffer significantly increased risks to radiation exposure side effects:

Cancer3 times the risk
Cataracts6.3 times the risk
Hypertension1.5 times the risk
Skin Lesions2.8 times the risk

In addition, cardiovascular disease and diminished reproductive capacity may also be linked to chronic, low dose radiation exposure. 

2015 article on Radiation Dose Management by Diagnostic and Interventional Cardiology referred to a study authored by Ehtisham Mahmud, M.D., FACC, FSCAI, chief of cardiovascular medicine, director of Sulpizio Cardiovascular Center Medicine and director, interventional cardiology at University of California San Diego. 

According to the study, interventionalists received 16 times the ambient radiation level to the left side of the head during an invasive CV procedure. Interventional cardiologists typically stand anteriorly to the patient, with the left side of their body closest to the patient’s chest and most proximate to the radiation source.

“The implications of this study are significant when considering the subsequent impact ongoing exposure to even low levels of radiation can have on the health of the practitioner over the course of their career,” said Mahmud.

Michael Seymour, director, advocacy programs for the Organization for Occupational Radiation Safety in Interventional Fluoroscopy (ORSIF), concurred. “While it is widely known that exposure to ionizing radiation can cause serious adverse health effects to medical practitioners, the adverse health impact on an individual is determined primarily by the dose to which he or she is exposed. Dr. Mahmud’s study clearly suggests that interventional cardiologists receive a very high level of radiation exposure to the head – specifically, to the left side of the head – creating a greater risk of brain tumors, brain disease and other serious illnesses,” Seymour said.

 “Hospitals need to investigate technologies that position operators farther from the source of radiation to reduce or eliminate the potential for long-term health risks on medical staff without compromising patient outcomes.”

Chronic spinal issues

As if the impacts of radiation exposure weren’t enough, the incidence of chronic spinal issues far outweigh those of the general population. One study reported operators have a 60% incident rate of chronic spinal issues with greater than 21 years of service verus 2.3% in the general population. 30% of them have spine related periods of absence, with some unable to resume work. 

In 2017, the Society of Interventional Radiology: Occupational Back and Neck Pain and the Interventional Radiologist reported that 70 percent of their sample of Interventional Cardiologists experience lower back pain, 40 percent experience neck pain and 42 percent experience both. They concluded that the high prevalence of neck and back pain among interventional radiologists is likely the result of a combination of the chronic effect of wearing protective garments, standing for long periods of time, and maintaining awkward, ergonomically unsound positions. The resultant repetitive stress injuries may be disabling. Interventionalists should be aware of this occupational hazard and embrace actions that reduce the risk, including careful design and planning of the interventional suite, attention to monitor and table position and use of shielding systems that reduce or eliminate the need for protective garments.

The technology solution

Dr Bob Foster, one of America’s highest-volume and successful Interventional Cardiologist (IC), created Rampart along with a team of designers and engineers. When Dr. Bob Foster, a triathlete in peak physical health, suffered a second ruptured disk—an injury that caused a month-long paralysis in one of his legs and left him out of the cath lab for two years—he knew it was time to do something about the heavy lead aprons that he believed were the cause of his injuries.

Rampart, made available exclusively in Australia and New Zealand by Wilhelm, is a fully adjustable and portable system that provides proven, full-bodied radiation protection for interventionalists and their technicians, all without having to work under heavy lead aprons. For the first time in over 100 years, this enables them to ‘Shed the Lead”. It improves radiation protection to the entire body including eyes, face and upper arms (areas which previously had no protection) and removes the long-term orthopaedic effects of wearing heavy lead aprons. 

Operating with Rampart

Not only does Rampart provide superior protection from radiation, it also gives interventionalists multiple vascular access points, including right radial, bi-lateral femoral and bi-lateral pedal. Its flexible design could potentially accommodate new procedures in the future. 

The time for change 

Fortunately, for the interventionalists, we’re seeing progressive facilities considering the Rampart technology solution to enable them to ‘shed the lead’.

Given the compelling reasons to do so, we’re hoping that more hospitals and medical facilities will make the change to improve the safety and quality of life for people going about the daily execution of their roles. 

To learn more about this revolutionary technology, contact the Wilhelm Team here.