Strategies for Supporting Teams During Complex Image-Guided Cases

Modern hospitals are increasingly incorporating image-guided procedures using technologies such as X-ray fluoroscopy, CT, and ultrasound, sometimes with a small incision or needle puncture instead of open surgery. Just a few of the most common procedures of this type are angioplasty and stent placement, tumor ablation, and image-guided biopsies. Images help medical personnel work more efficiently and safely, but they can also be lengthy and technically demanding, since they require professionals to work close to the patient and imaging equipment. As such, it is vital for hospitals and clinics to support physicians, nurses, and technologists in improving worker safety and enhancing the quality of patient care.

Ergonomic Problems in Image-Guided Procedures

A Mayo Clinic study of 1,543 employees found work-related pain among 62% of technicians, 60% of nurses, and 44% of attending physicians working in interventional laboratories. The high pain rates—especially for technicians and nurses—are heavily linked to the prolonged standing and heavy lead protective aprons required during radiation-based procedures. Numerous additional factors can make ergonomic design more challenging for teams relying on image-guided procedures. These factors include the need to wear heavy lead aprons during procedures such as fluoroscopy-guided angiography, the need to tilt the head or turn the neck or upper body to view monitors, and the need to reach across the patient to manipulate wires and catheters during procedures such as endovascular aneurysm repair. A limited ability to move during delicate procedures, such as cerebral angiograms, may mean holding a specific position while concentrating on high-resolution imagery for long periods. Finally, poor equipment placement can force staff to bend or reach while staff compete for space with other specialists and anesthesia equipment.

Designing Rooms Around the Clinical Workflow

Ergonomic design involves positioning equipment in accordance with real workflow needs. Procedural tables, imaging systems, monitors, surgical lights, anesthesia equipment, and storage should all be placed so that they do not require excessive reaching or interfere with staff movement. In cases where C-arms (advanced X-ray machines) and other imaging equipment are used, the placement of this equipment should ensure that it can move without colliding with tables, carts, staff, booms, or ceiling-mounted equipment. Displays should be positioned so that operators can view images without sustained neck or torso rotation. Finally, the patient’s head should always be accessible for emergency airway management and anesthesia needs.

Utilizing Purpose-Built Interventional Radiology Procedure Carts

Purpose-built interventional radiology (IR) carts are mobile, point-of-use storage carts designed specifically for image-guided procedures. The main function of medical supply carts is to store essential supplies and keep them within easy reach of surgeons, operators, and assisting staff. Their contents may include needles, syringes, catheters, guidewires, contrast supplies, and various procedure-specific accessories. The use of mobile carts means that healthcare staff do not have to walk to fixed cabinets, bend to access the contents of low storage units, or reach across other equipment. The organization of these carts is key. Their contents should be arranged according to procedure type and frequency of use. Standardizing layouts is also key, as it allows staff to know exactly where to find the necessary supplies. Carts must be positioned so that they do not obstruct the sterile field, imaging system movement, or emergency access.

Enhancing Departmental Efficiency

Optimal departmental efficiency can enhance ergonomics and safety within departments. Data-driven systems must be created to ensure that cleaning, restocking, equipment preparation, patient preparation, and room checks adhere to a strict, verifiable schedule. An organized system can help staff avoid unnecessary problems that can cause delays, including missing equipment, poorly stocked cabinets, and specialist equipment that has not been correctly prepared. Dedicated procedure carts can be used to keep the specific instruments and consumables needed for particular procedures. For instance, vascular intervention carts can be stocked differently from biopsy or drainage carts. That way, preparation and restocking can become more predictable. An Emory University Hospital quality-improvement project demonstrates the potential impact of systematic workflow improvements. After an interdisciplinary team mapped delays across six interventional radiology rooms and introduced targeted changes, on-time starts for the first case of the day increased from 23% to 56%, while patient-care delay time fell by 29%.

Supporting medical teams in complex image-guided cases requires a multifaceted approach that includes ergonomic room design, purpose-built interventional radiology procedure carts, and enhanced departmental efficiency. Hospitals must make data-driven decisions to reduce common problems such as neck strain, falls, and poor equipment positioning. Systems must also be set up to reduce common problems that can cause delays, including inadequately prepared equipment and missing supplies.