How Do I Know Which Aprons to Order for My Clinic?
- Greg Turner - The Radiology Coach
- May 2, 2023
- 8 min read
Updated: Aug 27
Back in 2021, I was hospitalized for 6 months. I'll spare you the details, other than to tell you that it had significant life-altering consequences. It seemed like I had virtually everything done to me while there: getting intubated, multiple surgeries, countless blood draws, and unending procedures.
Among those procedures were diagnostic x-rays. Although I was excited to visit the department of my profession, I was disappointed at one of the realities that I was forced to acknowledge. The radiologic technologists never offered lead protection for my examinations. And the only time that I did wear lead was when I asked for it.
These specialists are well educated and know the risks of not incorporating shielding into their workflow of patient care. Now I'm not stickler for always wearing lead, but I at least expected to be offered the choice of protection. They, as professionals, know that this is a commitment that they are trained to oblige.
This blog entry is to address strategies for both patients and employees in secondary and tertiary markets (not hospitals). As a manager or owner/physician in clinics, it is imperative to have protocols in place for all individuals and circumstances.
I decided that those who are associated with my coaching or teachings will know where I stand on these issues. In a nutshell, all patients should be given the courtesy to be offered lead protection during their exam. If they refuse, that is their prerogative.
As a final point before proceeding, there are aprons that do not have lead in them or are made of partial lead. These are less "toxic" and they weigh less too. If that is a desire, you might consider looking at their lead equivalent to determine which ones you prefer. Oh, and they are more expensive too!
Patient Protection
I've never seen the following comment in any publication or radiology publication. It may reside somewhere, but in 37 years, I haven't seen it published. And yet it is a very valid and important concept:
You should have separate aprons for patients and staff. Nowhere in the medical industry will you find medical employees sharing garments with patients. And yet, in most medical practices, these protective aprons are used interchangeably. In fact, if you ask which aprons are for who, most staff cannot delineate.
That point being made, there is a decision tree for purchasing aprons for both populations. Here are the questions to be considered when shopping for these garments:
What type of exams am I performing on these patients?
What is the age range of this population?
What is the size(s) of the population?
Will the weight of the aprons be a factor?
The most important questions among all 4 of these is number one: What type of examinations are you performing?
It must be noted that the American Dental Association conducted extensive research and separate from the environments stated below, determined that it is not necessary drape patients with lead aprons for their teeth x-rays. Some practitioners continue to cover their patients, but it is appropriate to mention that before we proceed to the other specialties.
If you are a podiatrist and are performing foot and ankle x-rays explicitly, then you'll want to look at light (.25mm thick) half-aprons, or waist aprons. These are easier to manage less expensive. You can do full aprons, but because of the low patient dose, and the localized area of which you are radiating, half-aprons are appropriate.
Chiropractors are more involved with core body x-rays, as they are focused on the spine. Their ability to cover the patient during examinations can be precarious, at best. This is partly because most chiropractors do all of their x-rays upright. There are diverse opinions on this topic of lead protection within the specialty, but here are my thoughts on it:
The lead actually absorbs scatter radiation, and as a byproduct, this can actually improve the image of the affected region. So, it actually behooves the doctor to apply protection when performing examinations. That being said, the office should consider purchasing a half-apron and/or an apron rack as protectants against radiation. The specialist can apply the half apron around the waist for thoracic spine exams and the apron rack for cervical spine work. The rack can also more effectively protect a pregnant individual during various image acquisitions.
Keep in mind that there are additional tools that can be used, but we are addressing the lead aprons specifically.
Standard diagnostic x-ray departments within orthopedic centers, urgent care facilities, and general practices should have half-aprons, full aprons, and x-ray racks in their facilities, specifically for their patients. Because there are hundreds of x-rays that can be performed in these environments, the aprons must be available for versatility.
Surgery centers and pain medicine clinics invest in fluoroscopic c-arms for their procedures. Although their ability to shield patients can prove to be futile, it is important to have these tools available for at risk patients and pregnant women where focused and precise shielding can be applied when needed. This usually comes in the form of a half-apron or full apron.
Veterinary clinics provide a variety of diagnostic examinations for their animals. It is not common for clinics to apply lead aprons for their patients. If a clinic desires to protect the animals, a half apron would be entirely useful.
Secondly, the most precarious population at risk with x-rays is our youth. Pediatric patients should be treated with care and protected at every chance available. This does not mean that they are compromised when they are exposed, but it does mean that medical personnel should always have their back and be cognizant at all times.
The only real difference between youth and adult imaging when it comes to lead aprons is that x-ray specialists should apply the lead as much or as frequently as possible.
Third, the size of the population is relevant to the protection of the patient because an apron that is appropriate for a 300-pound man will swallow a 120-pound woman or teenager. So, yes, in addition to the standard aprons indicated above, it may be necessary to purchase two separate sizes of aprons for a diverse population. Youths may require smaller aprons for pediatric applications.
It is up to the clinics to determine the size of aprons that they need, but the endgame here is to make sure that you have aprons available for all patients.
Last, it is important that these aprons can be very heavy. If you order the .5mm thick aprons for your patients, more than likely it will be uncomfortable to some. Have you ever sat in a dentist's chair and noticed how heavy their x-ray aprons are? Those are almost always .25mm thick. A .5mm thick apron would twice as heavy!!
Here is the point where I mention that in most cases .25mm thick aprons are entirely appropriate for most applications. It is not necessary to weigh down patients with bulky garments. We get into the thicker aprons mostly with fluoroscopic studies, and even then, specific medical staff will wear them. We'll address that in the next section.
Staff Protection
Protecting medical staff is a much more in-depth analysis, so we will abbreviate these listings. Again, there are similar questions to be asked about what aprons to consider:
What exams are being performed?
What type of equipment is being used?
Will there be cases where staff must hold the patient?
Is there a lead wall or barrier between the x-ray tube and where the x-ray generator is?
We will walk through the specialties as seen above, this time in the context of protecting staff. As opposed to the narrative above, we won't address each question separately, but you will see these themes throughout the following descriptions.
Dental employees typically do not need to wear protection when they are stepping out of a room to make their exposures. However, hand-held x-ray units have penetrated these markets in recent years.
If the employee is using a hand-held x-ray generator to shoot their images, it is highly recommended that they wear a .25mm lead full-apron for this procedure. Although not mandatory, dentists might consider accessories for their employees as well such as thyroid shields (.25mm) and lead goggles.
Podiatry is unique in that although they typically use low dose x-rays on a limited part of the patient's body, employees can be very remiss in abiding by the six-foot exposure rule where they need to retreat to that distance before making and exposure. The podiatry x-ray machine is different than other specialty devices because the generator is often located next to the tube head. It does allow users to take the exposure control and step back as far as 10 feet, however, it is very common for staff to get too relaxed with this.
As a result, I would recommend that podiatry assistants and podiatrists should have employee full aprons with .25mm thickness. In addition to that, the doctor should consider providing enough aprons for operators to work together positioning and exposing the patient. Hence, at least two aprons would be appropriate for two-man teams.
Chiropractors, orthopedic practices, general medicine, and urgent care facilities all have protective barriers that shield them from the primary and secondary x-ray beams. Although x-ray aprons are not necessary for standard operating procedures, there are the occasional patients that require assistance with standing or holding still. In such cases, the staff should have lead aprons available to them. .25mm thick full-apron garments will suffice.
Veterinary medicine is unique and specialized. They x-ray animals both when they are anesthetized and when they are awake. The vet team usually is required to be table-side when these x-rays are performed. Therefore, it is fully appropriate to provide enough aprons for 2–3-man teams. Aprons appropriate for this need only be .25mm thick. But in addition, the vet should consider .25mm accessories such as gloves, thyroid shields, and lead protective goggles.
Surgery centers and Pain Medicine clinics yield the highest exposures among these groups because they rely on fluoroscopic x-ray devices for their procedures. Because there are a variety of individuals in the examination room during procedures, the aprons will differ according to the individuals' responsibilities.
The doctors performing procedures are constantly within inches of the x-ray beam. Whenever possible, they should wear .5mm full aprons, .25mm thyroid shields, and lead goggles. If they are standing during long procedures, then the weight of the .5mm may be too much to bear and a .25mm garment will do. It is advisable to look into alternative aprons that are .5mm equivalent but significantly lighter than the lead counterparts.
Surgical assistants or nurses assisting with the procedure should also wear full aprons, but because they are usually not as close to the beam, the lighter .25mm lead apron, thyroid shield, and goggles are apropos.
The x-ray operator stands adjacent to the x-ray generator or close to it. They need only to wear a .25mm full apron, but it is recommended, because they are exposed to the primary beam at times that they wear accessories such as a .25mm thick thyroid shield and lead goggles.
Circulating nurses, although not often close to the primary beam, are often the most susceptible in the room because they are frequently answering calls, preparing trays, doing paperwork, moving equipment, etc.. It is impossible for them to be completely protected from the x-rays unless they are wearing a .25mm Vest/Kilt lead apron design. This is a two-piece that completely wraps around the body for full protection of mobile employees.
Again, remember that medical personnel should have separate aprons than the patients.
Taking That Step
In closing, this blog entry was written because I have spoken with countless end-users in the field over the last two decades. There are no training camp, coaching, or classes that address many of the questions that we bring up here. The environment of learning for most doctors on these topics is by osmosis and observation, often without putting these practices to the test.
I do hope this helps in your quest to properly protect your patients and staff. If you need a couple of resources to find these aprons, try some of these links:
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