Lightweight Lead Aprons: The Emperor's New Clothes in the Angiography Suite?

Abstract

The aim of this study was to test the performance and labelling of garments that are in contemporary use for radiation protection. A significant proportion of garments failed to comply with international labelling standards and did not provide the protection claimed by manufacturers. In addition, garments labelled at the same lead equivalence performed vastly differently in attenuation of scatter. These findings were demonstrated in the real world setting, by testing garments that are in current use across multiple centres. The study highlights current concerns regarding radiation protection standards and the need to identify composites that can consistently provide better protection than lead. Objective: The aim was to determine whether lead containing and lead free composite garments in current use provide the level of radiation protection stated by manufacturers. Methods: Fifteen garments, produced by five different manufacturers using eight different composites, were randomly selected for testing from four hospitals in South Australia. Labelling, material composition, design, and condition of the garments were assessed by direct garment examination, garment label, and product information. Garment attenuation was tested in a simulated angiography suite using a Siemens Ysio Max digital Xray machine. The front and back panels of each garment were tested under direct beam at 100 kVp. A Perspex phantom was used to simulate the density and scatter properties of the human abdomen. The front panels of each garment were tested under scattered radiation at Xray tube voltages of 50 and 70 kVp. Results: Forty-seven per cent of front panels and 90% of back panels provided lower lead equivalence than claimed by the manufacturer. Twenty per cent of front panels and 62% of back panels tested did not meet the minimum International Electrotechnical Commission requirements for angiographic use. There was a 38 fold difference in front panel performance of garments to scatter radiation, which were all labelled 0.5 mm lead equivalence. 56% of garments had differences in scatter transmission of at least 49% when tested at 50 and 70 kVp. Conclusion: The results show that lead containing and lead free composite garments probably provide less radiation protection than manufacturer stated lead equivalence. The demonstrated wide variations in attenuation of scatter radiation are greater than previously reported. It was found that most garments failed to comply with labelling standards. The study highlights challenges in radiation shielding and the need to identify composites that consistently provide better attenuation per unit weight than lead.

Quality of radiation protection aprons and quality control routines at different diagnostic imaging modalities

“…Leadfree aprons might weigh up to 25% less (6). However, the measured lead equivalent of leadfree aprons might be lower than expected according to some studies (2,(7)(8)(9), fact disproved by other studies (6,10).…”

New-old methods of reducing and monitoring x-ray exposure in the interventional radiology environment

“…Jak wynika z informacji dystrybutorów, ulegają one ponadto recyklingowi lub przynajmniej są bezpieczniejsze w utylizacji. Jako materiał tłumiący wykorzystuje się w nich głównie związki bizmutu, berylu [9], wolframu, antymonu, tytanu, magnezu lub mieszaniny tych pierwiastków [10]. Stosowane pierwiastki cechują się lepszą niż ołów efektywnością w pochłanianiu fotonów promieniowania RTG w zakresie 40-88 keV.…”

“…Lu i wsp. [9] wykazali jednak, że fartuchy bezołowiowe mogą pochłaniać promieniowanie w stopniu mniejszym niż podany przez producenta ekwiwalent grubości ołowiu. Badacze stwierdzili, że 47% przetestowanych części przednich 15 fartuchów bezołowiowych i 90% ich części tylnych cechowało się zawyżonym ekwiwalentem ołowiu, tzn.…”

“…Badacze stwierdzili, że 47% przetestowanych części przednich 15 fartuchów bezołowiowych i 90% ich części tylnych cechowało się zawyżonym ekwiwalentem ołowiu, tzn. stanowiły słabszą osłonę przed promieniowaniem RTG, niż zakładał producent [9].…”

Shields Up! How Much Should You Rely on Your Lightweight Garments?

“…Manufacturers often provide attenuation properties at a single beam energy (which is not particularly representative of vascular surgeons' daily practice), whereas it is well known that this varies significantly over the photon energy spectrum, especially with lightweight aprons. 4 In the study by Lu et al in this issue, 5 the authors demonstrated that in a random selection of "good shape" radiation protection garments found in the operating room, the Xray attenuation properties of the front panel were lower than expected in half the cases. Moreover, when garments had a back panel, attenuation was below the value stated by the manufacturers in 90% of cases.…”