Browsing by Subject "Occupational safety"

AbstractProject 1: Measuring the Effects on Operator Dose of Changing Clinical Settings Purpose: This study was initiated as part of a multi-faceted investigation of occupational dose to Interventional Radiologists consequential to their role as operators of fluoroscopy equipment. This project aims to qualitatively evaluate general dose reduction techniques, including clinical protocol settings on different interventional fluoroscopes to determine the specific impact on operator dose at Duke University Hospital. Materials and Methods: For each unit, analogous baseline settings were selected with a general abdominal protocol. The patient table was set to a source-to-object distance (SOD) of 62.23 cm (24.5 in) and a patient phantom was placed in the beam as a scatter medium similar to a typical patient abdomen. An anthropomorphic “operator” phantom was draped with a lead apron and positioned to one side of the patient table with an ion chamber placed at collar level. The ion chamber was placed such that the center of the active volume was 38.1 cm (15 in) lateral to and 63.5 cm (25 in) inferior from the center of the flat-paneled detector. A series of scans was taken on each unit, with each one having a selected variable changed, and the exposure readings from the ion chamber were recorded for comparison. Results: The effects on operator exposure rate of personnel height, contour shield use, cine mode, magnification, low dose mode, and source-to-image distance (SID) were analyzed. Operator height was found to have a larger effect on exposure rate reduction with distance than anticipated. Use of the contour shield reduced the operator exposure rate by over 90% on each unit. Use of cine mode drastically increased the exposure rate to the operator, while magnification, low dose mode, and decreasing SID all resulted in lower exposure rates. Conclusions: Operators can utilize these results to contextualize the effects of their own dose reduction techniques. Knowledge and familiarity of the techniques which offer the best exposure rate reduction can guide radiation protection practices among staff and help to optimize occupational doses. Project 2: Developing a Conceptual Framework for Analyzing the Radiation Dose Structured Report Purpose: When investigating occupational dose to Interventional Radiologists, it is important to be able to accurately compare metrics related to dose from historical procedures. The Radiation Dose Structured Report (RDSR) provides characteristic data from historical procedures. With an appropriate framework for analyzing RDSR data, performance metrics between operators or units can be compared, and identified trends can be used to develop dose reduction techniques specific to the organization. Materials and Methods: RDSR data from five interventional fluoroscopy systems (K1 – K5) was extracted for a three-year period from July 2019 through August 2022, and multiple metrics of comparison were selected for analysis. To determine differences in machine output, air kerma rates of similar procedures were compared, as well as the overall machine utilization for each year. Differences in operator-selectable variable were compared through air kerma rate per procedure, fluoroscopy time per procedure (limited to central line procedures), and operator caseload makeup. Results: Machine comparison of air kerma rates showed a consistently higher median and variability on the Philips Allura systems compared to the other three units. The Philips AlluraClarity unit in suite K2 was noticeably under-utilized by Interventional Radiology staff due to it being the primary fluoroscope used by Neurosurgery staff who were outside the scope of this investigation. Operator air kerma rates were compared from August 2021 through August 2022 and largely showed similar median values and variability. Fluoroscopy time per procedure fit to lognormal distributions and compared through their distribution parameter μ showed a median value which dipped during the second year for most providers. One operater also had a consistently higher median time per procedure for all three years. Conclusions: The analysis described by this framework provides a means of utilizing RDSR data to compare performance of interventional procedures. Continual local analysis of these metrics can be used to guide operator training to ensure that occupational doses are optimized to be as low as reasonably achievable. This is an initial approach that can be expanded through investigation and further characterization of procedure data included in the RDSR.

Background: Brick kiln workers in Nepal are a neglected population who are exposed to high concentrations of respirable silica. We aimed to characterize the prevalence of respiratory personal protective equipment (PPE) use, understand knowledge and attitudes towards kiln dust and respiratory PPE, and identify factors associated with current respiratory PPE use among brick kiln workers in Nepal. Methods: We conducted a cross-sectional study in Bhaktapur, Nepal. We used simple random selection to identify 10 out of 64 total kilns and stratified random sampling to enroll workers aged ≥14 years and household members aged ≥9 years within selected kilns. Field workers surveyed participants using structured questionnaires. Our primary outcome was to characterize prevalence of current respiratory PPE use, and secondary outcomes were summaries of knowledge, attitudes, and practice of PPE use. Results: We surveyed 83 workers (mean age 30.8 years, 77.1% male). Of these, 28.9% reported current respiratory PPE use at work. 3.6% of workers heard of silicosis prior to the survey and 24.1% correctly identified the best respiratory PPE for reducing dust exposure. Respiratory PPE users had higher income (non-brick kiln season mean monthly household income USD 206 vs. 145) and education levels (25% vs. 5.1% completed more than primary school) compared to non-users. Conclusions: Prevalence of respiratory PPE use was low. Workers had poor knowledge of kiln dust health effects and proper respiratory PPE. We highlight important barriers to PPE use, particularly knowledge gaps, which can guide future investigations to reduce silicosis burden among brick kiln workers.

Background: Persistent organic pollutants, combustion byproducts, and chemical contamination are just some of the occupational hazards that firefighters are exposed to both from dermal exposure when responding to fires and from contamination of their own personal protective equipment (PPE). Although the National Fire Protection Association (NFPA) 1851 PPE Care and Maintenance guidelines provide recommendations about how firefighters should clean their gear after a fire, there is variability in gear cleaning, and current gear cleaning practices are less than optimal. Understanding potential influences of knowledge, behaviors, and attitudes such as each fire department’s resources, shift logistics, and culture is a critical step in developing policies and interventions to improve gear cleaning practices. The aims of this study were: 1) to describe gear cleaning knowledge, behaviors, and attitudes among North Carolina firefighters, and 2) to explore demographic factors related to knowledge, behaviors, and attitudes. Methods and measures: 5 firehouse departments in North Carolina were surveyed for their gear cleaning attitudes, behaviors, and knowledge. 4 linear regression models were used to determine potential demographic predictors, and explore their potential association with our firefighter’s knowledge, behaviors, and attitudes related to gear cleaning. Results: Overall, indirect attitudes towards gear cleaning were positive, but behavior scores did not reflect firefighter’s knowledge. Race, education, and age were shown to be significant predictors, but years on the job failed to. Conclusions: While this is a novel study that addressed an understudied population, policies and interventions need further research needs to address gaps between knowledge and behaviors related to gear cleaning. There are several potential factors that could be influencing this gap such as differences in resources between each fire department, shift logistics, and firefighter culture that need to be reflected in future policies and interventions to improve gear cleaning practices.