A Novel Defense Against “Interventionalist’s Disc Disease”

Wearing a lead apron over time is known to cause neck pain, back pain, fatigue, orthopedic disability, and early retirement. The OrthoVest is a protective, backpack-like apparatus that is worn under a lead apron. It transfers the entire weight of the lead apron to the hips in upright and bent-over standing positions. The OrthoVest protects the neck, shoulders and spinal column like an exoskeleton, without restricting movement. It can be used by every employee who needs to wear a lead apron to perform their job.

The Scourge of the CV Profession

Lead aprons place considerable pressure on the neck, shoulders, and spinal column. Wearing lead aprons for hours while standing and maintaining awkward positions frequently has detrimental consequences. For decades, publications have highlighted the alarming prevalence of orthopedic injury, neck pain, back pain, and fatigue among invasive cardiologists. Publications have illustrated a causational relationship between these problems and wearing lead aprons. A January 1997 article in the American Journal of Cardiology1 noted that lead apron-wearing cardiologists “reported more neck and back pain, more subsequent time lost from work, and a higher incidence of cervical disc herniations, as well as multiple level disc disease.” The article notes that “’Interventionalist’s Disc Disease’ is a confirmed entity” and that it is “possibly a consequence of lead apron use”.

An August 2000 article in the American Journal of Neuroradiology2 describes a study finding that “cardiologists who wore lead aprons had a significantly higher incidence of skeletal complaints and more days missed from work because of back pain than did individuals of the control group.” The author also warns that “wearing a 15-pound lead apron can place pressures of up to 300 pounds per square inch of intravertebral discs.”

The damage caused by lead apron use extends beyond the healthcare provider, because it can reduce the workload of cardiologists and force early retirement; this may create access to care challenges, forcing hospitals to rely on locum providers in the short term and requiring them to recruit new physicians earlier than expected.

The OrthoVest

The OrthoVest is a semi-rigid exoskeleton that attaches to a belt. Because it is worn under the lead apron, it transfers all of its weight to the hips, bypassing the spinal column, neck and shoulders. This may help avoid damage caused to these areas from bearing the weight of a lead apron. The OrthoVest also creates an air gap between the lead apron and the healthcare professional wearing the lead apron. The increased air circulation may help reduce sweating and improve respiratory function, and ultimately, reduce the fatigue associated with wearing lead aprons. The OrthoVest can be used by every healthcare provider who is required to wear a lead apron for their job.

Legacy Solutions

Historical efforts to reduce the axial load on the spine consist primarily of lightweight lead alternative aprons, two-piece apron/skirt configurations, and suspended lead shields. These approaches each have merits and remaining challenges. Lead alternative aprons generally do not provide as much radiation protection as traditional lead aprons, two-piece configurations still place considerable force on the spinal column, and suspended lead shields are generally only able to protect one person in the cath lab. In addition, a March 2015 study in the American Journal of Cardiology3 establishes that the incidence of musculoskeletal pain is considerably higher among technologists and nurses than physicians.

For additional information and to purchase an OrthoVest, please visit 

  1. Ross AM, Segal J, Borenstein D, et al. Prevalence of spinal disc disease among interventional cardiologists. Am J Cardiol. 1997; 79: 68-70.
  2. Pelz DM. Low back pain, lead aprons, and the angiographer. AJNR Am J Neuroradiol. 2000 Aug; 21(7): 1364.
  3. Orme NM, Rihal CS, Gulati R, et al. Occupational health hazards of working in the interventional laboratory: a multisite case control study of physicians and allied staff. J Am Coll Cardiol. 2015 Mar 3; 65(8): 820-826. doi: 10.1016/j.jacc.2014.11.056.