by Salynn Boyles

Musculoskeletal injury is a well known occupational risk among hospital-based healthcare workers, and this risk may be greatest for physicians and staff working in cath labs, researchers reported.

When staffers at patient care facilities operated by the Mayo Clinic were surveyed, musculoskeletal pain was reported most often by those who routinely worked in cardiac cath and interventional radiology laboratories.

Nonphysician staffers who participated in interventional procedures reported higher rates of musculoskeletal pain than physicians, and female sex, time per week participating in procedures involving radiation, and increased use of lead aprons were all associated with a higher prevalence of pain, researcher Mandeep Singh, MD, of the Mayo Clinic, Rochester, Minnesota, and colleagues wrote in theJournal of the American College of Cardiology.

Overall, surveyed workers who were routinely involved in procedures involving radiation reported a 67% increase musculoskeletal pain prevalence, and they were also more likely to have received medical care for pain than workers who were not involved in such procedures.

Technicians, Nurses Reported More Pain

There are increasing concerns about radiation exposure to doctors and support staff working in interventional labs, but the study is one of the few to examine not just cancer risk but orthopedic injury among interventional lab physicians, nurses, and technicians, Singh told MedPage Today.

One surprising finding, he said, was that nurses and technicians reported higher rates of work-related musculoskeletal pain than physicians even though they tended to be younger.

“It may be that technicians who are assigned to cath labs tend to stay there, while physicians have other responsibilities,” he said.

The main objectives of the multisite, case-sectional study was to better understand whether working in interventional laboratories is associated with a higher incidence of musculoskeletal pain, cancer, and other medical conditions than working in other hospital-based patient care positions.

A total of 2,682 employees of cardiology and radiology departments at six Mayo Clinic patient care centers were identified, and 1,542 (57%) completed the survey (554 cardiology, 989 radiology). The average age of respondents was 43 ± 11.3 years and two out of three respondents (66%) were female.

Overall, 1,042 respondents (67.5%) reported being involved with procedures involving radiation, and these workers were assumed to work in interventional laboratories. Just over half the responders reported working as technicians/technologists (54.3%), while 18.3% were registered nurses, and 13.4% were physicians, 9.3% were other professions, and 4.7% were residents with means of 15.5, 16.1, 18.8, 11.3 and 4.0 years, respectively, in the field.

Among the major findings related to job-related pain:

• Employees involved in procedures utilizing radiation were more likely than other employee (controls) to report experiencing work-related pain (54.7% versus 44.7%; P<0.001).
• This association persisted after the researchers adjusted for confounding variables including worker age, sex, BMI, pre-existing musculoskeletal condition, years in the profession and job description, with radiation-exposed workers reporting a 67% increase in the prevalence of musculoskeletal pain (odds ratio 1.67, 95% CI 1.32-2.11; P<0.001).
• Among workers with radiation exposure, those who reported a history of work-related pain were more likely to be female (71% versus 56%;P<0.001), have more weekly exposure to radiation (median 15 versus 5 h/week), and wear the lead apron more (4 versus 1 hr/week; P<0.001).
• Technicians working in interventional labs reported pain most often (62%), followed by nurses (60%), attending physicians (44%), and trainees (19%).

‘Epidemic of Lab-Worker Orthopedic Injuries

The survey did not show a higher rate of radiation-exposure conditions such as malignancies and cataracts among the interventional lab workers compared with the controls, but the researchers noted that conclusions regarding causality were limited by the cross-sectional design of the study.

“I think we need more longitudinal follow-up with a larger cohort of personnel to answer this question,” Singh said.

In an editorial published with the study, cardiologistJames A. Goldstein, MD, of Beaumont Hospital, Royal Oak, Michigan, wrote that the study by Singh and colleagues highlights an “epidemic of orthopedic injuries … believed to be related to and aggravated by wearing personal radiation protective apparel (‘lead aprons’).”

“As procedures grow in volume and become increasingly complex and prolonged, it should not be surprising that interventional progress has been attended by an escalating epidemic of occupational-induced orthopedic afflictions,” he wrote.

Goldstein noted that efforts to reduce radiation risk to interventional laboratory staff are resulting in less exposure per procedure and potentially less risk of orthopedic injury.

“Technologies now available include ceiling-suspended individual lead aprons, shielded gloves, shielded scrub caps for cranial protection, and vascular robotic technology,” he wrote. “We can only hope the pipeline will yield a cornucopia of ever-better solutions. Our patients, society, and our spines will be beneficiaries.”

• Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner

last updated 02.24.2015