What do lead aprons protect

I think it just turns out that the hospital or physician's office that does x rays usually has a variety of apron sizes and they choose the one most appropriate. The dental offices, on the other hand, typically have one size and use it for everyone. Lead aprons reduce the radiation dose to the reproductive organs from a variety of diagnostic x-ray procedures.

Radiation has a potential of causing germ cell mutations that may be passed on to future generations. However, studies of the Japanese survivors of the atomic bombings and their offspring suggest that the doses necessary to produce genetic damage is quite high—much higher than typical diagnostic x-ray procedures.

Lead aprons serve a precautionary purpose to reduce dose. If the risk of thyroid cancer is so low, particularly in relation to x-ray medical staff, why are thyroid shields used?

Even though risk is low, it is prudent to reduce radiation dose when it is feasible and practicable. Using lead shields to block the thyroid is an easy dose-reduction strategy and costs purchase of lead apron or shield are relatively inexpensive over their usable lifetime.

Where is the lead located in the protective clothing worn by radiographers? Is it in an inner layer of the material?

Or is it mixed throughout the material, therefore coming into contact with bare skin when worn? Protective clothing worn by radiographers contains lead and often other metals e. These metals are homogeneously mixed with synthetic rubber or polyvinyl chloride PVC. The materials are cut into a pattern and sewn together to form the protective garment. The manufacturers of these garments vary the number of sheets, the percentage of metal, the grade of rubber or PVC, and the mixture of metals to affect flexibility, durability, radiation absorption efficiency, and weight.

None of the listed suppliers are endorsed. When you discuss the radiation received from x rays, are lead aprons taken into consideration? Does a lead apron decrease the radiation received as a patient? Typically, we do not take a lead apron into consideration for patients undergoing medical procedures involving radiation because the area of interest will not be covered. Lead aprons are taken into consideration if the person is occupationally exposed we make an assumption that if a person is in an x-ray room during a procedure, but is not the patient, a lead apron is worn or if the question specifically asks about the use of aprons.

If an apron were in the primary x-ray beam between you and the x-ray machine, the apron can stop at least 90 percent of radiation from entering your body. It is not practical, however, to put an apron over a body part of interest to the physician. Lead aprons have to be inspected visually every six months.

Where does this requirement come from? Lead aprons are used in medical facilities to protect workers and patients from unnecessary radiation exposure from diagnostic radiology procedures. Due to standards set forth by The Joint Commission , health care organizations must perform inspections on medical equipment, including lead aprons. State departments of health may also have a regulation stipulating that lead aprons be checked.

The Joint Commission standard does not dictate inspection frequency, method, or rejection criteria, although state regulations might. This allows facilities to develop their own policies and procedures to evaluate their lead aprons. Typically, a facility will perform an inspection of each apron on an annual basis.

Some facilities choose to survey their aprons on a more frequent basis, such as every six months. Operational Radiation Safety S51—S53; addresses implementing an inspection program and includes techniques for testing aprons. Operational Radiation Safety S67—S69; proposes a rejection criteria based on effective dose equivalent, that is, the whole-body dose based on dose to various critical organs. The following questions have come up for someone who is occupationally exposed to radiation but unable to wear a lead apron supported at the shoulder due to a medical restriction.

What is actually being protected by the chest apron section? Is it sufficient to wear a lead skirt only and perhaps stand behind a lead-glass shield during the performance of medical fluoroscopic procedures?

Lead aprons are very effective at absorbing diagnostic x rays to the parts of the body shielded by the apron. Their effectiveness is energy dependent but averages around 90—95 percent. Leaded aprons are worn as good radiation safety practice and in keeping with the ALARA as low as reasonably achievable concept. Whether or not a lead apron is worn, the allowable exposure to the body is governed by the occupational exposure limits. The ALARA principles of time, distance, and shielding are basic strategies to reduce radiation exposure.

Lead aprons and thyroid shields are the most frequently used personal radiation protective devices, but their importance is often overlooked. Protective devices that are used inappropriately or are not properly cared for increase the risk of radiation exposure. The use of well-fitting and lightweight lead aprons and thyroid shields, as well as regular annual inspections, are effective and important ways to use personal protective equipment.

Both proper education and training on the appropriate use of radiation protective devices and equipment should be mandatory to reduce radiation exposure in practice. National Center for Biotechnology Information , U. Journal List Korean J Pain v. Korean J Pain. Published online Oct 1. Find articles by Bo Kyung Cheon. Find articles by Cho Long Kim. Find articles by Ka Ram Kim. Find articles by Min Hye Kang.

Find articles by Jeong Ae Lim. Find articles by Nam Sik Woo. Find articles by Ka Young Rhee. Find articles by Hae Kyoung Kim. Find articles by Jae Hun Kim. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Correspondence to: Jae Hun Kim. This article has been cited by other articles in PMC. Abstract C-arm fluoroscopy is useful equipment in interventional pain management because it helps to guide correct needle targeting for the accurate injection and drug delivery.

Keywords: Fluoroscopy, Ionizing radiation, Pain management, Protective devices, Radiation exposure, Radiation protection, Thyroid gland. Major sources of radiation exposure during C-arm fluoroscopy There are three types of ionizing radiation exposure sources: 1 direct exposure from the primary X-ray beam, 2 scattered radiation reflected from patient's body or table, and 3 leakage from the X-ray tube [ 9 ].

Biological effects of radiation exposure There are two major biological effects of radiation exposure: 1 deterministic and 2 stochastic [ 12 ]. Radiation exposure of pain physicians When the human body is exposed to radiation, many organs of the body are affected.

Open in a separate window. Radiation protective devices Appropriate shielding is the most important factor in protecting individuals from radiation exposure. Radiation safety education Radiation safety education is important to protect patients and medical staff. References 1. Factors affecting radiation exposure during lumbar epidural steroid injection: a prospective study in patients.

Korean J Radiol. Historical review of occupational exposures and cancer risks in medical radiation workers. Radiat Res. Radiation exposure to physicians during interventional pain procedures. Correlation of patient and staff doses in interventional cardiology. Radiat Prot Dosimetry. The radiation safety education and the pain physicians' efforts to reduce radiation exposure.

Radiation safety and education in the applicants of the final test for the expert of pain medicine. Radiation safety in pain medicine. Reg Anesth Pain Med. Radiation safety among cardiology fellows. Am J Cardiol. Dagal A. Radiation safety for anesthesiologists. Curr Opin Anaesthesiol. Radiation exposure to the physician in interventional pain management. Pain Physician. Radiation protection of medical staff. Eur J Radiol. Blakely EA. Biological effects of cosmic radiation: deterministic and stochastic.

Health Phys. Thyroid dose during neurointerventional procedures: does lead shielding reduce the dose? Cardiovasc Intervent Radiol. First analysis of cancer incidence and occupational radiation exposure based on the National Dose Registry of Canada. Am J Epidemiol. Effectiveness of protective measures in reducing risk of radiation exposure in interventional pain management: a prospective evaluation.

Curr Pain Headache Rep. Fluoroscopy radiation safety for spine interventional pain procedures in university teaching hospitals. Brain and neck tumors among physicians performing interventional procedures.

Ionising radiation and risk of death from leukaemia and lymphoma in radiation-monitored workers INWORKS : an international cohort study. Lancet Haematol. Subclinical carotid atherosclerosis and early vascular aging from long-term low-dose ionizing radiation exposure: a genetic, telomere, and vascular ultrasound study in cardiac catheterization laboratory staff.

Radiation exposure from musculoskeletal computerized tomographic scans. J Bone Joint Surg Am. ICRP publication ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs--threshold doses for tissue reactions in a radiation protection context.

Ann ICRP. Approved by the commission on April 21, ICRP ref However, experts continue to recommend that health care workers in the imaging area protect themselves with leaded barriers as a matter of occupational safety.

Groups in Canada and Australia have endorsed the change, and a movement to abandon lead shields is underway in Great Britain, according to Marsh.

Shielding is used for most of the 70, X-ray procedures performed annually at Lurie in a variety of settings, from orthopedics to the emergency department. Kate Feinstein , chief of pediatric radiology. Some hospitals are concerned about violating state regulations. Some states are revising their regulations. In some cases, hospitals have applied for waivers or sidestepped state rules by taking the stance that a shield has the potential to affect diagnostic quality anytime it is used, Marsh said.

The amount of radiation needed for an X-ray is about one-twentieth of what it was in the s, and scientists have found no measurable harm to ovaries and testicles of patients from radiation exposure that comes from diagnostic imaging after decades of looking at data. Nevertheless, some patients may insist on shielding. The US National Council on Radiation Protection and Measurements NCRP limits the maximum annual total body dose for medical staff to 50 mSv, with a cumulative maximum lifetime limitation on exposure to radiation of 10 mSv per year of life of classified workers e.

The International Commission on Radiological Protection has stricter exposure limits, set at 20 mSv annually [32]. The maximum exposure allowed to the general public i.

At this dose, risks of radiation-induced health effects are either nonexistent or too small to be observed. The effects of cumulative lifetime exposures smaller than approximately mSv in occupational workers, exposed to low levels of radiation, did not lead to radiation-related adverse health effects in the most reliable studies available [34]. When applying these thresholds to our results as measured under the apron in both trunk and thyroid, we calculated that they will be surpassed after about 1, surgeries in an open approach, the equivalent of about 16 years of work for a surgeon preforming surgeries a year.

If using robotic guidance in a minimally invasive approach we surpass the threshold of mSv after 3, surgeries, the equivalent of about 39 years of work of performing surgeries a year. The main apparent weakness of this study is that we did not methodologically track the aprons being used, nor did we assess the effectiveness of the lead aprons by irradiating them directly in the beam path with TLDs above and under them.

Assessing the direct blockage of radiation by the apron would reflect on the lead apron but would not be telling on the real life exposure of the surgeon; 3 the lead aprons worn during this study are used daily by operating room staff in a modern and well equipped, tertiary referral center and a leading teaching hospital in South Korea.

We would assume that these results might occur at many, if not most, other facilities globally. It merits consideration and caution by surgeons who should reassess their protective practices, as these might not be as good as they believe, creating a false sense of safety. This report does not address issues such as X-ray source position, collimation and other parameters that influence the absolute exposure, but rather, focuses on the protective capacities of the lead aprons.

However, our absolute X-ray dosages are equivalent to those found in the professional literature in this type of surgeries. Another potential limitation is the fact that only 8 pairs of TLD measurements were used in our study. However, it would be sound science if other centers would attempt to reproduce our results. Our results question whether use of lead aprons could be considered good protective practice? In this prospective study assessing the extent lead aprons protect surgeons from intraoperative X-ray radiation emitted by C-arms, the 0.

Use of robotic-guidance in a minimally invasive approach demonstrated a reduction of Seung-Jae Hyun: Conceived and designed the experiments; Performed the experiments; Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Wrote the paper. Ki-Jeong Kim, Tae-Ahn Jahng: Conceived and designed the experiments; Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data. Hyun-Jib Kim: Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. National Center for Biotechnology Information , U. Journal List Heliyon v. Published online May Author information Article notes Copyright and License information Disclaimer. Seung-Jae Hyun: rk. This article has been cited by other articles in PMC. Associated Data Supplementary Materials Study protocol. Abstract Background Despite the firmly established occupational risk of exposure to X-rays, they are used extensively in spine surgeries.

Methods Single-center, prospective, randomized study of adult patients with degenerative lumbar disorders, scheduled to undergo posterior lumbar interbody fusion. Findings Sixty four patients were included in this study, 34 in the RO cohort and 30 in the FA cohort.

Interpretation The 0. Introduction X-rays are used extensively in medical practice in general, and in orthopedic and spinal surgery in particular, due to its excellent imaging abilities of bony structures.

Materials and methods 2. Design Single-center, prospective, randomized study of posterior lumbar interbody fusion performed in a robot-assisted, minimally invasive approach RO or a conventional, fluoroscopically-assisted, open approach FA.

Patients Adult patients presenting single or two-level degenerative lumbar spinal disorders scheduled to undergo primary fusion surgery, were eligible to participate in this study. Surgical techniques All patients underwent a spinal fusion by a posterior approach. Outcome measures Baseline data were collected, and included sex, age, height, weight and symptom duration. Open in a separate window. Statistical analysis Difference in exposure to radiation between the RO and FA groups recorded by the TLDs was compared between the 2 groups as a ratio.

Table 1 Baseline patient characteristics and surgical parameters by treatment cohort. Discussion As modern spinal surgical practice becomes increasingly less invasive, the requisite instrumentation accuracy has come at the cost of heightened intraoperative radiation doses [14].

Declarations Author contribution statement Seung-Jae Hyun: Conceived and designed the experiments; Performed the experiments; Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Wrote the paper.

Funding statement This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Competing interest statement The authors declare no conflict of interest. Additional information No additional information is available for this paper. Appendix A. Supplementary data Study protocol: Click here to view.

References 1. Klein L. Occupational health hazards in the interventional laboratory: time for a safer environment.