Unusual injury sustained by an escort in a radiology suite: Correlation with anaesthesiologists' plight.

Sir,

We would like to report an unusual case of injury sustained by one of the authors (MCM), coincidentally an anaesthesiologist, while escorting his 3-year-old daughter to have an X-ray of the left elbow joint done. The author was asked by the radiographer to sit on a stool at one end of the table and to place the child's elbow over the table while holding the child in his lap. The significant difference in the height of the stool and the X-ray table was preventing the proper position and the escort was unable to place the child's elbow over the table while he was sitting on a stool. He requested the radiographer to wait for sometime so that he could stand up to place the child's elbow on the table in a better way. But, the radiographer was prompt enough to actuate one knob to make the table down without any prior intimation. The downward movement of the table stuck the escort in that sitting position. The hanging perpendicular metal part of the table directly compressed the anterior compartment muscles of the left thigh of the escort who was unable to escape as he was caught between the metal part and the stool [Figure 1]. This resulted in closed injury of the rectus femoris, haematoma, subsequent healing with fibrosis and weakness of the limb.

Figure 1

The vertical metal piece of the x-ray table compressed the left thigh of the escort due to downward movement of the table. The victim was unable to escape as he was caught between the ‘vertical metal piece’ and the stool in sitting (hence, locked) position

The purpose of reporting this case is to make the anaesthesiologist aware of this fact, which has a resemblance with their one position in operating room (OR). During pre-oxygenation and airway maneuver, the anaesthesiologists sometimes put their legs under the head end of the table while sitting on a stool. The head part of the table remains folded vertically down, especially when the patient is a child or of short height [Figure 2]. If, suddenly, the table is lowered down to provide some ergonomic help, an injury can occur to the anaesthesiologist unexpectedly, especially to both thighs, although modern day tables come with autosensors that stop moving down the moment they sense any obstruction. However, there are many centres where older tables do exist and can invite this problem.

Figure 2

The anaesthesiologists sometimes sit on a stool in a ‘minus’ position (legs under the table) during any maneuver. Sudden lowering of the table without intimation may injure anaesthesiologist

Physical injury on health care providers with medical equipment are uncommon, but there are reports of the same.[1-3] Work-related strains over spine and various injuries are possible among the health care personnel, including the anaesthesiologists, who often actively participate in patient positioning. This may affect their quality of life. In advanced centres, patient handling is increasingly being performed with assistive equipment and devices rather than as a random task performed by untrained health care providers.[45] The use of modern devices for shifting the patients may invite new modalities of injuries. Training of anaesthesiologists at frequent intervals to familiarize them with modern devices can reduce such events.

Riley and Coombs[2] reported the actuation of the X-ray table control knob with the movement of a patient's foot during induction of general anaesthesia for endoscopic retrograde cholangiopancreatography in the radiology suite. This resulted in downward movement of the “C-arm”, which was left unaware above the head of the anaesthesiologist. Endotracheal intubation was rudely interrupted when the C-arm pushed the anaesthesiologist's head towards the patient's face. However, the radiographer in attendance quickly controlled the situation by reversing the movement just before the anaesthesiologist and the patient collided.

The radiology suite is often considered as an unfriendly atmosphere for an anaesthesiologist. The anaesthesiologists should ensure optimal position while performing any maneuver. Adjusting the height of the stool is a safer option than adjusting the height of the table.