“I needed a seat, my sciatica is really bad today,” said my EP colleague as I walked into his office at lunchtime, “it’s bad enough being sore with tingling down my leg, and then I get eyelid scissors that don’t cut…I never get sharp bloody scissors anymore!!”
There are many challenges being a cardiac interventionalist, but the occupational hazards, with its ongoing, and potentially significant impact on our future health, is one we often overlook. Today I thought I’d share some views on the orthopaedic problems, I’d be interested to hear what you think.
It’s been clear for some time that there is a high prevalence of orthopaedic issues, particularly related to the spine, in practitioners working in X-ray theatre. These occupational-related injuries not uncommonly result in missed days at work, surgery and for some, unfortunately, a curtailed interventional career.
Nearly twenty years ago, investigators called attention to a distinct occupational hazard they labelled “interventionalist’s disc disease”, as reflected by multiple disc pathologies in both the cervical and lumber regions together.1 In 2004, a Society for Cardiac Angiography and Interventions (SCAI) survey, showed nearly half of the 424 respondents reported spine problems; they found a significant relationship between the years worked in the cath lab and the incidence. 2
Efforts to better define all occupational risks (including orthopaedic) associated with working in a fluoroscopic laboratory led to the formation in the United States, of the Multi-Specialty Occupational Health Group (MSOHG), with member organisations from the cardiac, neurological and peripheral vascular interventional societies.3
I know there is the Healthy Cath Lab Study Group in Italy, but I don’t know if there is an equivalent group to MSOHG in the UK and/or Europe, does anyone know if there are discussions or plans ongoing?
What are the solutions for us to be less challenged and protected from our skeletally hazardous work-place? It’s clear there is a move into multi-modality imaging to complement fluoroscopy in not only cardiac, but all interventional work, and the technology is moving fast. But not quick enough for most current practitioners to expect to spend most of a therapeutic procedure without a lead coat on.
What about time limits on individual operators? Clearly this won’t be popular, but also difficult to police, and by whom?
Our profession and employers do have an interest and obligation, to keep us healthy in our workplace. Should occupational health play a bigger role in keeping us monitored and fit? More frequent and detailed risk assessments; stronger education; departmental pilates may be stretching it, but why not, if it will keep you well, and maintain comfortably the longevity of your career?!
There are some higher fidelity ways to address the problem available now.
The “Zero-gravity” system, avoiding the weight bearing of lead coats, has had some adoption. It does appear to be more practical than it looks, although the cost may be limiting, especially in a public funded setting. Is this last thought reasonable though? Days and weeks off work are expensive, as is losing the knowledge and expertise of any senior in their field. Would it be an unreasonable accommodation due to cost, maybe for one operator, but what if more?
Most radically, and possibly not only for the X-box generation, robotic PCI . It has a small but increasing amount of data to show it is feasible and safe for the patient but what about the tactile feedback for a start?
Discussing this recently I shared that in the echo room 20 years ago at least once a month we had a commercial diver who’d had a neurological bend, and a bubble study for PFO detection; I can’t remember the last time this happened. The reason? Commercial divers have been largely replaced by ROVs and their drivers. Not that much difference between a ROVs driver’s skill set to that of a cardiac interventionist’s? The case activity now with robotic PCI is not yet CTOs but what can’t be done by a ROV now, that divers still have to do…not that much probably?
Recognising the problem, then wanting solutions are the first steps, but bringing change into effect won’t be simple.
The MSOHG met with the Medical Imaging and Technology Alliance (MITA) in October 2008. MITA represents the major medical imaging equipment manufacturers: General Electric, Philips, Siemens, and Toshiba. MITA asked for a prioritised list of specific objectives to help them prioritise its R&D initiatives and have a shared intention to produce solutions to these, including the orthopaedic concerns.4
And finally, how will the additional financial expense of new innovations be covered?
We are increasingly aware of the occupational hazards of an interventional career, it probably wouldn’t have stopped most of us entering into it but it is clearly overdue to improve the workplace and maintain our physical health whilst practising. We don’t get another skeleton, nor another set of intervertebral discs, in the same way we can get another pair of eyelid scissors!