Radiation Protection During Mobile Exams

Do you wear a lead apron during portable exams?

I have found in my years of experience as a radiologic technologist that practices vary from one radiologic technologist to the next.  Of course, we utilize some form of radiation protection when it comes to using a c-arm for mobile fluoroscopy in the operating room.  Fewer people wear lead when performing plain film images during surgical procedures.  And most don’t seem to worry about radiation protection during routine portable exams like chest x-rays and abdomen films.

Why is this?  

We learn in school that lead shielding is required when performing these exams.  For those of you who do not wear radiation protection for mobile exams, I am about to show you something which may cause you to change the way you prioritize wearing radiation protection apparel.

For some context, I want to step back in time, when Computed Radiography (CR) was first implemented at a hospital I was a clinical instructor for.  My job was to accompany student technologists while they performed their exams and to educate and evaluate.  Having never been to the operating room at that facility, I was given the opportunity to tag along with one of the staff techs who had been observing my student for the day.  They were assigned to perform a cross-table lateral lumbar spine image during a discectomy.

I watched as the staff technologist carefully walked around the table, being mindful of the sterile field, and positioned the draped image receptor next to the patient.  My student used the portable x-ray machine to align a horizontal beam to include the lumbar spine for the prone patient.  When they were finished setting up, they indicated to the O.R. staff in the room that they were ready to expose the image.  All of them, including the physician left the room while the three of us from the radiology department stayed to make the exposure.

We had taken two CR image plates into the room with us.  One was positioned next to the patient, and the other had been placed against the wall behind us.  The student made the exposure, extending the full length of the cable that attached the exposure switch to the portable x-ray machine, which was about 12 feet.  The staff technologist and I backed up to the wall behind us – I would guess an additional 3 feet behind the student technologist who exposed the image.  We all wore lead aprons.

Upon returning to the radiology department to develop the image, the student made a mistake that every technologist has done in their career.  He was carrying both the exposed image plate of the lumbar spine image as well as the unexposed image plate that had been resting against the wall behind us, and he forgot which one was the exposed plate.  The logical solution was to process both image plates under the “lateral lumbar spine” algorithm and discard the image that was not exposed.

The first image was not the lumbar spine image we had hoped it would be.  Instead, something peculiar appeared on the monitor in front of us as the scanner slowly revealed more and more of the image during processing.  Once the entire image had been scanned and the processing the algorithm was applied, it was clear that this was an image of a lower leg (a portion of the tibia and fibula).

Thinking we had come across someone else’s image plate that had been exposed for a different patient (and thankful we did not use that plate to image the lumbar spine), we began asking around the department to see if anyone was missing a tib-fib image from any of their exams.  No one was missing an image.  I decided to examine the image further on a PACS monitor for larger viewing.  The image quality was poor, and the resolution was horrible.  The exposure indicator proved that the image was slightly over-exposed.  I then realized what I was looking at.  This was the cassette that was leaning against the wall in the operating room approximately 15 feet from the patient that was x-rayed.  If you recall, the staff technologist and I had backed up against the wall prior to the exposure being made for the lumbar spine.  This was an image of the staff technologist’s leg, which was positioned just a few inches in front of the image plate during the lumbar spine exposure.  This was purely created by scatter radiation from the exposure we took in surgery.

Here are some examples of images created solely from scatter radiation in an experiment based off of lessons learned from this experience:

S# was 1190 at 8 foot distance from lateral lumbar spine phantom, which indicates about 1/4 the exposure required to produce a diagnostic hand x-ray

S# was 980 at a 6 foot distance from lateral lumbar spine phantom

I also decided to x-ray a chest phantom to simulate a portable chest x-ray using 120 kVp and 5 mAs. The following image was created from scatter radiation from about 10 feet away from the chest phantom.

S# was 2780

Though the last image produced from the chest phantom didn’t receive nearly the exposure as the one from the lumbar spine phantom, it is still obvious that there is enough radiation to penetrate the fingers from 10 feet away.  Now that you’ve read this and seen evidence of the radiation we work with every day as a radiologic technologist, are you going to change your practices?  If you already use radiation protection for your mobile exams, will you encourage your co-workers and student technologists to adopt these habits?

Registered radiologic technologists vow to keep radiation dose “As Low as Reasonably Achievable” (ALARA).  It is our duty not only to protect patients from the harm that can be caused by radiation, but to protect yourself and your co-workers from it as well.  Let us not forget the three basic principles of radiation protection; time, distance and shielding.  Keep the amount of time you are exposed to radiation low.  Keep as much distance from a radiation source as possible.  And finally, use shielding, including during mobile examinations.  Consistent application of all three of these basic principles of radiation protection will keep you, your patients and your co-workers as safe as possible.

About the Author 

Jeremy Enfinger is an experienced Radiologic Technologist, Radiography Program Instructor, and published author. He has served in leadership roles in hospital, outpatient and academic settings. His experience includes writing examination questions for the national ARRT Radiography Exam and multiple – modality training. He continues to pursue excellence in education and patient care. An avid blogger, Jeremy strives to promote standards of excellence in imaging through his online community with the sharing of veteran tips and techniques for high-quality imaging.

Additional Reading Written by Jeremy Enfinger via Topics in Radiography Blog

Experiments with Scatter Radiation (original post from 2009 – with updated images and technical factors)

Reducing Radiation Dose in Diagnostic Radiography

Podcast: How To Communicate Radiation Risks To Patients

What Everyone Should Know About Digital Radiography

Gold Standard Cleaning For X-Ray Aprons & Lead Wearables

What Does Gold Standard Cleaning Look Like For X-Ray Aprons And Lead Wearables?

Thus far in this lead apron based blog series, we have examined the infection issues and concerns associated with contaminated lead x-ray aprons and the science behind how staff members can easily test such surfaces for contamination using ATP testing.

This third blog entry will examine methodologies and practices utilized by clinical staff and facilities in the “cleaning” and maintenance of these protective lead wearables, and also explore what “cleaning” such a surface really entails. In discussing bioburden levels in the previous blog, we addressed how one cannot judge cleanliness on a surface by appearance alone.  Let’s take a deeper dive into what it means to truly clean and sanitize these protective, lead garments.

Survey Says…

In researching the topic, speaking with professionals at symposiums and inquiring with colleagues and peers, there is little consistency across the continuum of care with how these garments are cleaned and/or serviced. Shockingly, a number of Radiology, Cath Lab and Operating Room staff have lamented that such surfaces “never” get cleaned, while other staff and administrators have shared that such surfaces are sometimes cleaned, “when the case load is light on a Friday” or “on the midnight shift by the environmental services department.” Both patient and staff safety are at risk due to lack of staff compliance and clinical efficacy issues posed through improper cleaning practices.

Online research lead to a few administrators sharing that they ran these lead aprons through a cart washer, which lead manufacturing companies clearly advise not to do. Clinicians have also shared that they try to use products such as Lysol or Febreeze to “eliminate the odors” yet admit the lead wearables still aren’t “clean.” One of the more popular concepts considered in attempting to clean and service these wearables entails the discussion of “using sanitizing wipes” on such high-touch surfaces.  Unfortunately, the use of these wipes alone does not properly clean and sanitize the garments.

Pesky Directions

There are a number of sanitizing/disinfecting wipes on the market that some clinicians claim to use on lead aprons and wearables. When taking a closer look at the labels on these products, one may very well discover that most wipes are actually not recommended for use on lead wearables. Additionally, some wipes contain bleach and corrosive agents, which are both advised not to be used on aprons, according to the companies that manufacture them. A majority of the wipes on the market today are indicated for use on “non-porous” surfaces such as tables, bed rails, door handles, etc. rather than a porous surface such as a nylon covering of a lead wearable. Though the use of wipes might afford convenience to the user, the real issue with doing so lies in their clinical inefficiency in successfully cleaning the surface, not to mention completely removing any bioburden.

Wax Then Wash?

If your car had dirt, road tar and bird droppings on it, would you attempt to wax it in that condition?

For best outcomes, you would first clean and remove those elements before attempting to wax the car.  The same is true for other surfaces, including lead wearables.  Professionals who routinely assess bioburden understand the importance of a proper cleaning before sanitizing or disinfecting an item.  If an item is not properly cleaned and organic matter remains, nutrients also  remain to better foster the growth of surviving bacteria or future bacterial contamination.  This is by definition a risk factor for increased hospital associated infections.

All You Can Eat Buffet

In watching the news of late, one can gather that the world of microbiology is ever changing.  Bacteria are highly adept at persisting.  Through changes in their DNA they can gain antibiotic and/or antiseptic resistance, and these changes can happen through mutations or through integration of foreign DNA, but where would they find foreign DNA?  When bacteria die and the cells break open, then the DNA is accessible to the remaining bacteria.

The Problem with Sanitizing and Disinfecting Wipes

When facilities only use wipes on a surface and don’t completely remove the debris, they are in essence creating an “all you can eat buffet” for the surviving bacteria to thrive upon. If the dead bacteria had antibiotic or antiseptic resistance markers, now that DNA is fair game for susceptible bacteria to gain resistance!   In fact, numerous studies have shown that certain bacteria can pick up various genes from different species that makes them more pathogenic (either by making it antibiotic resistant, antiseptic resistant, or by allowing it to survive in a host better).

Layers Of Bacteria? Gross?

As if that wasn’t scary enough, what if I told you that some bacteria could gain antibiotic and antiseptic tolerance simply by growing?  (IT IS TRUE!)

Some bacteria can attach to a surface (particularly porous or textured surfaces such as lead wearables) and as they grow and form groups of bacteria (colonies) that can then form a biofilm.  Biofilms are clusters of bacteria that have attached and produced an extracellular polymeric substance (EPS) which are essentially a protective coating.

Extracellular Polymeric Substance (EPS)

EPS consists of DNA, proteins, lipids (fats) and polysaccharides (sugars).  This coating protects the bacteria inside the human body from cells that can either tag the bacteria for destruction or destroy the bacteria outright.  Externally (on a surface) it can protect the bacteria from anti-microbial drugs or antiseptic agents.  In fact, bacterial biofilms are 10 – 1,000 times more resistant to antibiotics than there standalone bacterial counterparts.  Their EPS is essentially a bacterial Teflon coating.  This Teflon coating only gets stronger when multiple species of bacteria co-inhabit the same biofilm, and if these attributes weren’t scary enough, bacteria in a biofilm can sense their microenvironment and may even produce toxins while in a biofilm that they wouldn’t normally produce.

Biofilm Life Cycle

Like all living things, biofilms have a life cycle, and a part of that life cycle involves dispersion of some bacteria that are then free to go and attach elsewhere, including in a human host. In 2007, the National Institutes of Health estimated that approximately 80% of chronic infections were biofilm related; thus, biofilms remain a serious problem in many facilities. When surfaces such as the nylon covering of a lead wearable are not cleaned properly, it allows different bacteria to begin to congregate.

Layers of Bacteria

Thinking this all sounds like something from a fictional book or movie, as if biofilms can only exist in some weird lab conditions or in some rare disease?  Nope!!!!

The most common example of a biofilm is one that everyone is probably familiar with, but may not realize is a biofilm, is dental plaque!  Biofilms are so hard to remove from surfaces that companies have spent millions of dollars trying to prevent their formation.  If you think about dental plaque, it makes sense.  We brush our teeth twice a day to best prevent plaque.  Unfortunately, when it comes to medical devices or any surface (particularly a porous or textured surface) in a medical treatment facility (such as lead wearables), biofilms can form once the surface is exposed to organic matter such as blood.  Now with the mental picture of layers of bacteria (such as plaque) on surfaces in medical treatment facilities, consider that some high-touch surfaces, such as radiological shields and aprons have not been properly cleaned for years (if ever!)

Elbow Grease Helps Break Up Biofilms

Biofilms are so tolerant of antimicrobials and antiseptics, that even the CDC positions the best way to remove a biofilm is to disrupt it physically, and they have included the ‘use of friction’ in their definition for proper cleaning.  Studies have been done that show that physically disrupting the biofilm by using friction is the primary means for destruction of the layers and thus removal of the biofilm.  (In the example of dental plaque, this would be equivalent of one going to the dentist and having them scrape the teeth in order to remove the plaque.)  The procedural process and outcomes are different when looking at the process of “cleaning” and “sanitizing” and it takes both of these separate processes to eradicate biofilms from porous, high touch surfaces. The surface on a lead wearable first needs to be cleaned before it can then be sanitized.

  • Cleaning – According to the CDC, cleaning entails the use of EPA registered products, coupled with the use of friction to physically remove dirt, microorganisms and bioburden and then removing/rinsing them away from the surface. Though a vast majority of the bioburden is removed during this process, the cleaning process does not always remove 100% of all bioburden & microorganisms.
  • Sanitizing – This process then “inactivates” 99.9% of all remaining microorganisms on environmental surfaces if allowed to sit visibly wet or “dwell” on the surface for the recommended amount of “dwell time” as per manufacturer instructions and guidelines.

Cleaning and Sanitizing really can’t be done in one-step, let alone with just a wipe. When you go to the dentist, the first step in the process is to scrape the plaque from the teeth before they are polished, just like your car needs to be adequately washed and dried, before it can be then waxed. Cleaning and sanitizing of a neglected surface such as a lead apron cannot be accomplished in one step either. In an effort to address such biofilms “head on” X-Ray apron servicing companies, such as Radiological Care Services (IN) are implementing multi-step, cleaning and sanitization programs for X-ray aprons and lead wearables. These programs are built in accordance with governing bodies, such as the CDC, JCAHO, AORN and HFAP, which position that surfaces should first be cleaned, before attempting to sanitize or disinfect them.

Stay Tuned For The Next Post

Stay tuned for the next follow up blog post, as we look specifically at what policies, regulations and expectations these governing bodies have of high touch surfaces, such as X-ray aprons and lead wearables. Between now and then, go brush your teeth and think about the layers of bacteria building up on lead wearables and aprons as they continue to invite bacteria to the biofilm party!

About The Author:

Kathleen R. Jones received her BS from Purdue University (West Lafayette) in Biology specializing in Genetics and Microbiology.   After working for five years in Quality Control she then completed her MS at Purdue University in Indianapolis.  Her growing interest in Infectious Diseases lead her to the Uniformed Services University of the Health Sciences where she obtained a Doctorate in Emerging Infectious Diseases.  Kathleen has a passion for progressive sciences and initiatives, and employs her keen understanding of the biofilm formation and elimination processes into her research and work.

Evaluating Microorganism Levels On X-Ray Aprons And Lead Wearables: The Science Of ATP Testing

How Have Microorganisms and Bioburden Been Measured?

In the previous blog post regarding X-Ray lead aprons, we explored the history of healthcare associated infections or HAIs, and how transmission risks are posed to patients and staff via contaminated “high touch, non-critical surfaces,” including X-Ray aprons and protective lead wearables.  In laying out the content of this blog, I was reminded of the phrases, “things aren’t always as they appear” and “don’t judge a book by its cover.” Is it possible that newer (clean looking) X-Ray aprons can carry a higher level of biological contamination when tested in comparison to older X-Ray aprons (which are dirty looking & smelling)? It is completely possible and plausible due to the concept of bioburden.

What is Bioburden?

Bioburden is defined in numerous medical dictionaries as the number of microorganisms contaminating an object.  So how does one assess for bioburden?  The gold standard for assessing for bacterial/fungal contamination has been to assess for colony forming units or CFUs.  A CFU equals one viable bacterium that has the ability to spread and replicate.

3 Main Ways to Measure CFUs: 

  1. A scientist could dilute the sample and count the bacteria by microscopic examination or through the use of a cell counter.  However, if bacteria are too small or clump together, then this method is problematic.  This method will yield total bacteria counts, both living and dead.
  2. A scientist could use Optical Density (OD) to estimate the number of viable bacteria in a sample.  This is where the scientist measures how cloudy a liquid culture of bacteria is.  While the bacteria are actively growing the liquid culture should continually become more and more cloudy.  Again, this method will yield total bacteria counts, both living and dead.
  3. A scientist could make serial dilutions of a liquid culture and plate out the bacteria in known dilutions until they can count single colonies and extrapolate back to figure out total CFU in a sample. This method only yields viable bacteria totals.

4 Challenges Associated with Bioburden Assessment

Assessing for bioburden (microorganisms) by calculating CFUs is not as easy or straight forward as one might imagine.

  1. The first challenge posed is that one needs to have a lab in which to grow bacteria, and depending on the bacteria one is dealing with there are different governmental regulations to follow.
  2. The second challenge presented is that of time, one needs to have the time and equipment to properly grow the bacteria/fungus.  Different species of bacteria or fungus grow at different rates, for example, culturing of bacteria on plates can take anywhere from overnight to multiple days.
  3. A third and very important challenge is posed by the bacteria and fungus themselves.  They are similar to people in the fact that not all of them grow and thrive under the same conditions.  In lab work, if only one kind of food source is used, one will only be able to assess for bacteria that grow on that particular food source.
  4. Finally, one needs to have a trained technician who knows how to assess which bacteria to grow under the correct conditions and then also how to properly count the bacteria.

While assessing for CFUs has traditionally been viewed as the gold standard for assessing bioburden, and it is vitally important for various microbial studies, it is not a good way to assess bioburden in real time.  It can be complicated.

What is ATP and How is it Evaluated?

What if there was an easier way to determine surface levels of biological contamination?

What if there was an easier way to assess for a molecule that is found only in living cells, both bacterial and human living cells?

There IS an easier way to evaluate for this molecule in real time (by using a simple swab and handheld reader), and it can be used by any hospital staff member as a surrogate for such complicated CFU work.  Let me introduce you to the molecule known as the “molecular workhorse,” called adenosine triphosphate (ATP).

Adenosine Triphosphate (ATP)

ATP is an energy molecule utilized by cells. It is present in humans, animals, plants and microbial cells.  ATP levels rise as a cell is undergoing apoptosis (programed cell death), but is generally consider to be completely degraded within 30 minutes of cell death (1).  This makes ATP a useful marker for the presence of unwanted biological contamination, including organisms that can cause infection and disease.

Okay – Get to the Point!

An increase in biological cells on a surface results in an increase in the amount of ATP present on that surface, thus making ATP an effective marker for the assessment of the hygienic status of an environmental surface. Simply stated, the amount of ATP present on a testing swab is a quantitative measurement of the cleanliness of the surface tested! In fact, ATP cell viability assays were determined to be the fastest, most sensitive, and least prone to artifacts, partially due to a lack of an incubation period (2).  The sensitivity of laboratory cell based ATP cell viability assays can detect fewer than 10 cells per well (2).  This technology has been modified to create a portable, ATP bioluminescence test, using a swab instead of plated cells.  This now allows for a real time assessment of bioburden on site.  These tests have been used to assess bioburden in many healthcare settings, including the ICU (3).  ATP measuring units, called luminometers, are handheld, user friendly, and display the results in seconds. (It doesn’t take a scientist to use an ATP luminometer!) The read out of an ATP bioluminescence test is not in CFUs, but is in relative light units or RLUs.  In the past, some scientists have questioned the validity of using a bioluminescence test instead of assaying for CFU.

Is There a Correlation Between CFUs & RLUs? 

Like most assessments, ATP bioluminescence assays also have limitations, but they are an excellent surrogate that allows the everyday staff member to assess bioburden in real time.  Those new to ATP bioluminescence testing often inquire about a correlation between CFUs and RLUs.  (Most laboratory microbiologists have the capability to perform CFU testing, and are not confined to real time assessment of bioburden.)  The most controlled way to achieve this is to look at different known amounts of CFUs and assess whether or not the RLUs increase accordingly.  That is exactly what Dr. Sciortino’s group did when they assessed three different portable ATP bioluminescence kits for their ability to detect various CFUs of two different HAI relevant bacteria (Staphylococcus aureus and Acinetobacter baumannii) and one strain of fungus (Candida albicans).

What they discovered was there was a linear relationship between bacterial CFUs and RLUs for all three luminescence kits, and for two of the three kits between fungal CFUs and RLUs (1).  Such research validates that the use of ATP luminometers can be used to assess for bioburden on surfaces in real time.  This research, plus Dr. Jaber’s study, in which 25 lead aprons were cultured for CFUs and showed that 21 were colonized with Tinea species (the family of fungus that causes ringworm) and 21 were colonized with Staphylococcus aureus, of which 3 aprons were colonized with MRSA (4), validates the ATP bioluminescence results for X-ray aprons and protective lead wearables.

In fact, these X-ray aprons and protective lead wearables, which are worn throughout many different areas within a healthcare system, including the operating rooms, cath labs, radiology/imaging areas, emergency rooms and beyond are regularly testing with RLU readings in the THOUSANDS to HUNDREDS OF THOUSANDS (5), which is scary. The bottom line is regardless if you are a classically trained microbiologist used to looking at CFUs or a hospital staffer looking at luminometer readouts in RLUs, when surfaces inside an OR or Cath Lab are testing in the hundreds of thousands range, it is a problem!

Is ATP Testing Growing in Use?

Through utilization of ATP luminometer testing systems, companies like Radiological Care Services (Indianapolis) are able to enter a facility’s Cath Lab, OR or Radiology Department and test lead apron inventories on site, providing real time numbers (bioburden levels) in a matter of seconds. An advocate for ATP luminometer testing, Dr. Sciortino even states, “ATP system monitoring may uncover the need for new disinfectant designs that adequately remove hospital surface biofilms, rendering used hospital equipment to its native state whereby a zero reading by ATP monitoring can be achieved” (1).  If you look back at the first blog post, “Contaminated X-Ray Aprons and The Risk of HAIs”, I positioned that “using wipes alone” was insufficient and through the use of ATP testing, Dr. Sciortino could be inferring a similar position.

Looking Ahead…

In the next blog post, we’ll specifically look at the science/methodology behind the use of sanitizing wipes and we’ll further explore the differences between true “cleaning” and “sanitization.” We’ll later examine what the governing bodies, such as AORN, CDC, HFAP and JCAHO state regarding their expectations of such surfaces within healthcare facilities. Understanding the science behind HAIs, testing for biological contaminants on surfaces, biofilms, and the difference between “cleaning” and “sanitization” will help us understand that current healthcare protocols in regards “non-critical, high touch surfaces” need to be changed in order to better protect hospital patients and staff.

About The Author:

Kathleen R. Jones received her BS from Purdue University (West Lafayette) in Biology specializing in Genetics and Microbiology.   After working for five years in Quality Control she then completed her MS at Purdue University in Indianapolis.  Her growing interest in Infectious Diseases lead her to the Uniformed Services University of the Health Sciences where she obtained a Doctorate in Emerging Infectious Diseases.  Kathleen has a passion for progressive sciences and initiatives, and employs her keen understanding of the biofilm formation and elimination processes into her research and work.

Sources:

  1. Sciortino, C. V. and R. A. Giles.  2012. Validation and comparison of three adenosine triphosphate luminometers for monitoring hospital surface sanitization: A Rosetta Stone for adenosine triphosphate testing.  AJIC.  40 (e233-9)
  2. Riss T.L., R.A. Moravec, A. L. Niles, H.A. Benink, T.J. Worzella, L. Minor. Minor, L, editor.  2013,  Cell Vialblity Assays. In: Sittampalam G.S., N.P. Coussens, H. Nelson, et al., editors. Assay Guidance Manual [Internet]. Bethesda (MD): Eli Lilly & Company and the National Center for Advancing Translational Sciences; 2004-. Available from: //www.ncbi.nlm.nih.gov/books/NBK144065/
  3. Moore, G., D. Smyth, J. Singleton, P. Wilson. 2010. The use of adenosine triphosphate bioluminescence to assess the efficacy of a modified cleaning program implemented within an intensive care setting.  AJIC. 38(8):617-622 DOI: //dx.doi.org/10.1016/j.ajic.2010.02.011
  4. Jaber, M., M. Harvill, E. Qiao.  2014.  Lead aprons worn by interventional radiologists contain pathogenic organisms including MRSA and tinea species.  Journal of Vascular and Interventional Radiology.  25:3:S99-S100.  DOI: //dx.doi.org/10.1016/j.jvir.2013.12.279
  5. “Outcomes: What do your numbers look like?” Radiological Care Services. Nov 20, 2014. //www.radcareservices.com/radiolgical-care-services-outcomes.html

Contaminated X-Ray Aprons And The Risk Of HAIs

Contaminated, Dangerous, and Unacceptable: The Impact of Contaminated X-Ray Aprons and the Risk of Health Care-Associated Infections (HAIs)

Infection Prevention checklists today include many new areas of concern such as contamination in lab coats, neckties, telephones, remote controls, privacy curtains and more. X-ray aprons and protective lead wearables are worn throughout many different areas within a healthcare system, including the operating rooms, cath labs, radiology/imaging areas, emergency rooms and beyond. Clinical studies have proven that X-ray aprons silently carry a number of microorganisms – Dr. Jaber (Wayne State) cultured 25 lead aprons to discover 21 were colonized with Tinea species (the family of fungus that causes ringworm) and 21 were colonized with Staphylococcus aureus, of which 3 aprons were colonized with MRSA (1).  

The Association of periOperative Registered Nurses (AORN) makes cleaning recommendations for items such as kick buckets, stools, patient restraints, keyboards, surgical lights and more; however, lead aprons which are routinely engulfed in sweat, blood, bodily discharge and surgical debris/residue have been consistently overlooked. Healthcare systems can no longer compromise both patient and staff safety through such perilous practices.  (Note – upcoming posts will further explore “current cleaning practices,” as well as cleaning recommendations and guidelines from National Governing Bodies such as the CDC/JCAHO/HFAP and AORN.)

Health Care-Associated Infections

HAIs are the 4th largest killer in the United States, claiming 100,000 American lives each year – more deaths than AIDS, breast cancer and auto accidents combined (2).

Hospitals are meant to be safe havens.  They are meant to be a place of refuge against disease, a place to heal and a place to recover from surgery or injury.  If that is the dream, then the nightmare would be a place in which you end up more ill than you were when you were first admitted!  Unfortunately, that nightmare becomes a reality for many unsuspecting patients and staff members today. One reason for this nightmare is the acquisition of a Health Care Associated-Infection or Hospital Acquired Infection (“nosocomial infection”).

The World Health Organization (WHO) uses a 1995 definition for a Hospital Acquired Infection (HAI):

An infection occurring in a patient in a hospital or other health facility in whom the infection was not present or incubating at the time of admission.  This includes infections acquired in the hospitals but appearing after discharge, and also occupational infections among staff of the facility (3).

HAIs in our Healthcare System

Think about it – it only makes sense that hospital acquired infections would be prevalent in our healthcare systems today.  Hospitals & medical facilities are places that people congregate when they are immunocompromised and/or are sick and in need of some type of care or treatment.

World Health Organization Study

In fact, a WHO study of various hospitals in 14 countries across Europe, Eastern Mediterranean, Southeast Asia and Western Pacific regions in the late 1980s concluded that 8.7% of patients had at least one Hospital Acquired Infection equaling 1.4 million afflicted people at any one time (4-5).

Centers for Disease Control and Prevention Estimate

In the United States alone, the CDC estimates roughly 1.7 million annual hospital-associated infections, from all types of microorganisms including bacteria combined, cause or contribute to 100,000 deaths each year (6). In fact, approximately 1 in 25 hospital patients has a hospital acquired infection at any one time (7). While these statistics are startling and horrifying, sadly they do not paint the complete picture. These statistics are patient specific and do not include the number of healthcare workers and hospital staff who have also acquired Hospital Acquired Infections.

Economic Impact of HAIs

Such infections lead to additional stress, longer hospital stays, lost wages for healthcare providers and higher morbidity and mortality rates overall.  HAIs also have a HUGE economic impact.  In addition to being the 4th largest killer in America, it is estimated Hospital Acquired Infections will cost the healthcare system an additional $30 Billion (2).

Why do HAIs Occur? 

We live in a medically advanced society, so why do Health Care Associated-Infections still run rampant, and what are we doing about them?  That is a good question, but the answer is multifaceted.  The first point to consider is that patients are usually immunocompromised when in need of healthcare services. They are either already ill or they have had a procedure that puts immense stress on their bodies, e.g., a joint replacement, major illness or other surgical procedure or treatment. 

As wonderful as modern medicine is, it is not without risks.  In fact, many diagnostic and/or therapeutic procedures involve the use of a medical device, e.g, catheters, intubation tubing, scopes, etc. These devices and even many “non-critical” surfaces and “high touch objects” such as X-ray aprons and lead wearables can become contaminated when not properly cleaned and sanitized.

Healthcare facilities are a place where sick and immunocompromised patients regularly navigate and patients are often transferred between units/floors.  This allows infectious agents to travel to different areas in a hospital and expose multiple people, including patients, family and staff members.

Infectious Agents

Infectious agents (bacteria, viruses, parasites, and fungi) present their own issues.  There are species that form spores that are resistant to most mechanisms of eradication. Kramer’s group recently performed a meta-analysis of the literature and summarized that most clinically relevant species of viruses could easily survive on dry, inanimate surfaces for between a few HOURS to DAYS and clinically relevant bacterial and fungal species could survive for DAYS to MONTHS (8).  The longer the infectious agent can be found in the environment the greater the chance that it can be passed to a new host.

The Need for New Policies/Protocols

Unfortunately, Health Care-Associated Infections (HAIs) are still a substantial source of morbidity and mortality throughout the healthcare continuum today.  While recent initiatives such as improved hand washing policies have helped that burden, there are additional new policies/protocols with regards to cleaning that need to be implemented in order to address other critical “high touch objects” such as X-ray aprons and lead wearables.

Education and Awareness

Through education and open-mindedness, we can bring awareness to the importance of following the cleaning recommendations of the governing bodies, such as the CDC/JCAHO/AORN and HFAP.  In knowing that infectious agents can still adapt to become drug resistant, antiseptic resistant, and increase their ability to survive in the environment, so, we too must adapt and be open minded to new concepts in our vigilant fight against hospital acquired infections.

Oft-Overlooked: X-Ray Aprons and Lead Wearables

X-ray aprons and lead wearables can no longer be overlooked, and they will need a renewed commitment to servicing. They need to be properly cleaned prior to sanitization efforts, in accordance with the guidelines of the CDC & JCAHO.  In my next blog entry, we’ll dive into the science behind testing X-ray aprons for the presence of microorganisms and examine how these surfaces are measured and evaluated.

SPOILER ALERT – If you think you have an idea of how contaminated such surfaces are inside of our healthcare systems, you will be in for a SURPRISE!

About The Author:

Kathleen R. Jones received her BS from Purdue University (West Lafayette) in Biology specializing in Genetics and Microbiology.   After working for five years in Quality Control she then completed her MS at Purdue University in Indianapolis.  Her growing interest in Infectious Diseases lead her to the Uniformed Services University of the Health Sciences where she obtained a Doctorate in Emerging Infectious Diseases.  Kathleen has a passion for progressive sciences and initiatives, and employs her keen understanding of the biofilm formation and elimination processes into her research and work.

Sources:

  1. Jaber, M., M. Harvill, E. Qiao.  2014.  Lead aprons worn by interventional radiologists contain pathogenic organisms including MRSA and tinea species.  Journal of Vascular and Interventional Radiology.  25:3:S99-S100.  DOI: //dx.doi.org/10.1016/j.jvir.2013.12.279
  2. “What is RID?” Committee to Reduce Infection Deaths.  n.p.  d.p.  Web.  Nov 7, 2014.  //www.hospitalinfection.org/objective.shtml
  3. Benenson, AS.  1995.  Control of communicable diseases manual.  16th edition.  Washington, American Public Health Association.
  4. Tikomirov, E.  1987. WHO Programme for the Control of Hospital Infections.  Chemiotherapia. 3:148-151.
  5. Mayon-White, RT, G.  Ducel, T. Kereselidze, E. Tikomirov.  1988.  An internal survey of the prevalence of hospital-acquired infection.  J. Hosp. Infect.  11 (SupplementA): 43-48
  6. Klevens, RM, JR Edwards, CL Richards, TC Horan, RP Gaynes, DA Pollock, DM Cardo.  2007.  Estimating health care-associated infections and deaths in U.S. hospitals, 2002.  Public Health Rep 122:160-166
  7. Magill, SS, JR Edwards, W Bamber, ZG Beldavs, G Dumyati, MA Kainer, R Lynfield, M Maloney, L McAllister-Hollod, J Nadle, SM Ray, DL Thompson, LE Wilson, SK Fridkin.  2014.  Multistate Point-Prevalence Survey of Health Care-Associated Infections.  N Engl J Med 370:1198-1208
  8. Kramer, A., I. Schwebke, and G. Kampf.  2006.  How long do nosocomial pathogens persist on inanimate surfaces? A Systemic Review. BMC Infectious Diseases.  6:130  Doi: 10.1186/1471-2334-6-130

When Is It Time For A New X-Ray Apron?

How Long Will My X-Ray Apron Last? 

The life of an x-ray apron will depend on the frequency of use, applications and how it is stored when not in use. Properly caring for your x-ray apron is the easiest way to extend the useful life of your apron. It is recommended to have the lead apron examined fluoroscopically at least once a year.

When Should I Replace My X-Ray Apron? 

“Any radiation protection garment displaying breaks in the lead lining should be replaced.” e.g. Rejecting an x-ray apron depends on the location, area size and number of flaws. It is best to keep the number of flaws to a minimum – Source: North Carolina Department of Health and Human Services, Division of Health Service Regulation, Radiology Compliance Branch, Radiation Protection Section¹

Lead Apron Integrity Inspection

X-ray aprons should never be folded. Cracks in the lead lining can develop at the fold reducing the useful life of the apron. The x-ray apron should be inspected annually or manufacturers recommendations.

Fluoroscopic Inspection

  1. Lay x-ray apron on the table
  2. Examine the entire x-ray apron using the fluoroscope
  3. Record results of the inspection following your facilities or state protocol

Fluoroscopic Inspection Alternative (When fluoroscopy unit is not available)

  1. Closely inspect the x-ray apron for kinks, creases, and irregularities
  2. Take a radiograph of the suspect areas (e.g. areas where the lead lining may be compromised)
  3. Process the film and inspect for breaks or flaws in the lead lining
  4. Record results of the inspection following your facilities or state protocol

Before Purchasing New X-Ray Aprons

Check with your Radiation Safety Officer to determine what lead equivalency is required to be compliant with your state’s radiation protection regulations. The American Registry of Radiologic Technologists has a helpful page that lists the contact information for each state.

 

Please Note: The information included in this post is intended for general reference only. The information provided is not a substitute for professional radiation protection advice and should not be relied upon in the absence of such professional advice.

5 Reasons Why You Should Use Lead Apron Storage Racks

Lead Apron Storage

Improper storage of your lead apron can reduce the attenuating qualities of the apron and ultimately reduce the level of radiation protection your apron provides. Lead apron storage racks come in a variety of styles and configurations to meet the specific needs of your medical facility.

Protection From Radiation Exposure

Lead aprons are used in medical facilities to protect workers and patients from x-ray radiation exposure from diagnostic radiology procedures. Lead aprons are protective garments that have been designed to shield the body from the harmful effects of ionizing radiation during medical imaging procedures.

“As is the case with many protective garments, it is important to remember that a lead apron is only effective when it is worn properly, matched with the appropriate radiation energy and is used in a safe and regularly inspected environment.” – Stanford’s Radiation Protection Guidance for Hospital Staff¹ 

Lead Apron Integrity Check

Medical personnel who are required to wear lead aprons or other related radiation protection devices should visually inspect these protective garments prior to each use for obvious signs of damage such rips and tears, sagging lead, and cracks in the lead lining.

Not sure if a lead apron rack is necessary?

1.  To ensure that you are properly protected. When a lead apron hasn’t been stored properly, you could be putting yourself at risk for increased exposure to ionizing radiation. Small cracks and holes can develop in the lead lining that may not be visible on the exterior fabric of the lead apron.

“Lead aprons should be checked fluoroscopically at least on an annual basis for their shielding integrity².” -Radiology Compliance Branch (Radiation Protection Section), NC Department of Health and Human Services

2.  To protect your radiation protection investment. Properly storing your lead aprons will extend the useful life of the apron by helping prevent damage to the lead lining and the exterior fabric of the lead apron. Aprons should never be folded or creased. Lead aprons should be hung up by the shoulder(s) or on an approved apron hanger. Aprons should not be stored on a flat surface. Even incorrect storage for a short time can result in damage that is not visible to the naked eye.

3. To improve the organization of lead aprons. Managing lead aprons is one task that the imaging director has to cross off their to-do list, although it is probably not at the top of their list. Lead aprons play a vital role in protecting physicians, imaging staff, and patients from unnecessary exposure to ionizing radiation during diagnostic imaging procedures. Properly organizing your aprons will simplify the tracking process and will make State or Joint Commission inspections easier.

4. To help improve efficiency. Having a centralized location to properly store lead aprons will keep them safe and easily accessible the next time they are needed. Properly managing lead aprons can be a time-consuming task, utilizing an appropriate lead apron storage rack can help reduce time spent tracking aprons in the medical facility. As departments grow, it is important to have an apron storage process in place to keep aprons from getting mixed between departments.

5. To help reduce the occurrence of missing aprons. Keeping track of aprons can be difficult, especially when physicians and imaging staff spend time at multiple facilities. Lead apron racks make storage easier and help reduce the chance of lead aprons getting moved between departments and other medical facilities.

Example of A Wall Mounted Apron Rack

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Stay Neat And Organized

Maintaining a neat, uncluttered imaging environment is important in detail orientated medical fields. Lead apron racks allow your facility to provide medical staff with a well-organized treatment facility and workspace. When the necessary equipment is readily available on an x-ray apron rack in a centralized location, X-ray procedures will be completed efficiently and effectively.

 

5 Ways To Minimize Your Occupational Radiation Exposure

Minimizing Occupational Exposure

“The ideal dose is the least amount of radiation possible to produce an acceptable image.”

1. Time

Time is one of the three basic safety measures to reduce external radiation exposure. It is important for healthcare personnel to limit the amount of time spent in close proximity to the radiation source when exposure to the radiation source is possible. Reducing the time of an exposure reduces the effective dose (radiation) proportionally. Consequently, the less time you are around the equipment, the smaller your exposure will be.

2. Notification by Radiation Equipment Operator

Before any treatment or procedure, it is the responsibility of the trained and certified radiation equipment operator to notify healthcare personnel in the x-ray or treatment room prior to the activation of radiation producing equipment (RPE).

Any piece of equipment in which x-rays are produced electrically are classified as radiation producing equipment or RPE. These tools are used in a variety of medical applications including radiography, mammography, computed tomography, and fluoroscopy.

3. Fluoroscopic Procedures

Healthcare personnel performing fluoroscopic procedures must ensure that the patient is kept as close as possible to the image intensifier side of the fluoroscopic unit and away from the tube side of the unit. All healthcare personnel involved in the fluoroscopic procedure must stand on the image intensifier side of the fluoroscopic unit, whenever possible, to reduce the radiation exposure. Standing on the the same side as the image intensifier radiation intensity is decreased.

4. Avoid Direct Beam Exposure

Healthcare personnel assisting with radiological procedures must avoid holding the patient manually during a radiographic study due to the risk of direct beam exposure.  Any individual holding or supporting a person during radiation exposure should wear protective gloves and apron with a minimum of 0.25 millimeters lead equivalent. Under no circumstances should individuals holding or supporting a person’s part of their body be directly in the primary beam. Healthcare personnel must avoid exposing any body parts to direct x-ray beam exposure.

5. Utilize Shielding

Whenever possible, appropriate shielding should be used to provide attenuation of the radiation being delivered to the healthcare personnel who are potentially exposed. Healthcare personnel must keep all body parts out of the direct x-ray beam. There are a variety of shielding options available and may include, but are not limited to:

Specific Shielding Applications

Healthcare personnel who may have to stand with their backs exposed to the radiation beam must wear wrap-around aprons to decrease the risk of radiation exposure.

Bone and Bone Marrow Protection

When healthcare personnel are in close proximity to the radiation beam they should wear an appropriate lead or lead equivalent apron of sufficient length to shield the upper legs and protect the long bones and bone marrow from increased doses of radiation.

Thyroid Protection 

Healthcare personnel must wear a thyroid collar to protect the thyroid whenever the likelihood of the procedure places them at a higher risk of increased exposure.

Female Healthcare Personnel 

Female healthcare personnel must protect their breasts from radiation exposure by utilizing an apron that completely covers the area.

Eye protection

Healthcare personnel must shield the lens of the eye by using leaded eyeglasses with wrap-around side shields or leaded face shields to reduce scatter radiation when it is anticipated that increased fluoroscopic time may be necessary.

Limiting Radiation Exposure 

Reducing radiological exposure in healthcare settings is important for both occupational workers as well as patients. The following guidelines are based on the radiation safety principles of time, distance, and shielding. By following these guidelines, you can reduce your occupational exposure to radiation.

 

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Note: This information included in this post is intended for general reference information only. The information provided is not a substitute for professional advice and should not be relied upon in the absence of such professional advice.

X-Ray Protective Apron Care: 9 Do’s And Don’ts

Proper X-Ray Protective Apron Care and Use

X-ray aprons serve a very specific purpose, to protect and shield you from the potentially harmful effects of ionizing radiation. Shielding, one of the three concepts of basic radiation safety, should always be used when the use of time and distance principles are not possible.

Protective x-ray aprons constructed of lead or a non-lead equivalent are designed to protect the radiosensitive areas of the body when it is necessary for the healthcare worker to be near the source of radiation. Typically, x-ray aprons will offer frontal protection of 0.5 mm lead equivalency. In some instances, wrap-around x-ray aprons are required when medical personnel will have their backs exposed to the radiation source.

By learning the proper way to maintain and care for your x-ray apron, you will ensure that you are properly protected and you will extend the life of the apron. Below are the four do’s and the five don’ts of proper x-ray apron care. After reading this post, you will know how to keep your x-ray apron looking good while also keeping yourself protected against the harmful effects of ionizing radiation.

X-Ray Protective Apron Do’s 

1. Inspect and Check Apron For Defects, Cracks, Creases, and Perforations 

Place the x-ray apron on a flat surface and visually check all the seams as well as the outer and inner covers of x-ray apron for any visible damage. Next, check the belts and fastening devices to confirm that they are in good condition. Lastly, inspect the surface of the apron with your hands to locate any potential lumps, cracks, sagging or separation from the apron seams. If the apron condition appears to be suspect, it should be inspected radiographically. “Rejecting an apron depends on the location, area size and number of flaws. It is best to keep the number of flaws to a minimum¹.”

Note: It is recommended that you follow the manufacturer’s recommendations and/or the state regulations regarding the proper care and use of lead protective equipment. 

2. Clean Regularly

X-ray Aprons should be cleaned daily and deodorized by scrubbing with a soft bristle brush, using cold water and a mild detergent. Completely remove cleaning residue by thoroughly rinsing with clean, cold water.

Apron Cleaning Tips

To ensure x-ray aprons are not damaged while cleaning, follow these helpful tips:

  • Never use products that contain bleach.
  • Do not soak or submerge x-ray apron in water.
  • Do not machine launder, autoclave or dry-clean.
  • Once cleaning is complete, if possible, hang the apron on the designated apron wall rack to air dry.

3. Properly Store X-Ray Aprons

The x-ray apron manufacturer’s recommendation regarding the proper handling and storage of the apron must be strictly observed. When not in use x-ray aprons must be stored on hangers to prevent cracks in the protective lead. If possible, do not store the x-ray apron on a flat surface. Aprons should be hung by the shoulder or on an approved apron hanger. Aprons should never be folded or creased, to avoid damaging the lead. “Cracks in the lead lining can develop at the fold, reducing the useful life of the apron¹.” Hook and loop fasteners must be secured properly to avoid snagging or tearing of fabric, always store apron with fasteners completely secured.

4.  Dispose Of Lead Aprons Properly

X-ray protective aprons that contain lead cannot be disposed of as municipal solid waste. Consequently, they must be disposed of as hazardous waste or recycled. The Environmental Protection Agency encourages recycling and reuse rather than disposal. According to the EPA, if the lead shield or apron can be reused by another business for its intended purpose then it remains a product, therefore it is not classified as waste or hazardous waste. Recycling the lead apron is the preferred method since it keeps the lead out of the landfill and extends the useful life of the lead apron. When recycling is not an option, you can contact a disposal service to properly dispose of the lead material.

X-Ray Protective Apron Don’ts 

5. Sit While Wearing Your Apron

Unless the x-ray apron has been designed specifically for seated procedures, you will want to avoid sitting while wearing your apron. Cracks in the lead lining can develop while wearing the apron if seated. Also, you will want to avoid sitting on the apron for the same reason.

6. Expose Apron To Extreme Temperatures 

To prevent damage to the apron, you will want to avoid exposing your x-ray apron to extreme hot or cold temperatures or to direct sunlight.

7. Lean Against Pointed Objects or Sharp Edges

Avoid storing sharp objects in the pockets. X-ray aprons can become damaged while leaning up against sharp or pointed objects, creating perforations in the lead lining and reducing the attenuating qualities of the lead.

8. Store Aprons Over Chair Backs or Equipment

Laying aprons over a chair back or piece of equipment can create creases in the lead lining and can reduce the useful life of the apron.

9. Fold Aprons

To prevent damage to the lead lining, avoid folding, wadding or creasing your x-ray apron.

Ensure Reliable Performance 

To ensure safe performance, as well as keeping your x-ray apron looking good for years to come, we strongly recommend that each x-ray protective apron is thoroughly inspected upon receipt and at regular intervals and properly stored when not in use.

X-ray aprons should be evaluated every 18-24 months to determine if replacement is needed, depending on the amount of usage and general wear and tear.  If you found this post helpful, please feel free to share this post or our SlideShare presentation with your colleagues.

 

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How To Choose The Right X-Ray Apron Style (Part 3)

Which x-ray apron style is right for you?

X-ray aprons are available in a wide variety of styles to meet the specific needs of medical professionals. Determining which lead x-ray apron style is right for you may seem overwhelming. The selection process can be simplified into several easy steps and in this post we will walk you through the necessary steps to ensure that you find the right x-ray apron as well as the appropriate level of radiation protection. The x-ray selection process can be broken down into three steps: (1) choosing your core material, (2) selecting the type of protection required, and (3) determining the best x-ray apron style for your needs.

Core Materials

In our previous post, How-To Determine Which X-Ray Apron Material Is Right For You, we discussed the three different types of core x-ray apron material options including traditional lead, lead composite, and non-lead. Each core material offers a distinct benefit, traditional lead aprons are the most economical, lead composite aprons provide an average weight savings of 25% compared to traditional lead aprons, and non-lead aprons are the lightest weight option available. Once you have determined the core material you can then choose the type of protection needed.

X-Ray Apron Coverage Protection Options

When selecting the type of radiation protection required for your specific application, it is important to understand the unique benefits each style offers. The three common x-ray apron styles are front protection, front/back protection, and quick-drop. Front protection x-ray aprons are ideal for those who only require front-protection during procedures. X-ray aprons that offer front and back protection are designed for those who circulate and will have their back to the radiation source.  The quick- drop x-ray apron has been designed for those who need to remove the x-ray apron during surgery without breaking the sterile field.

Understanding The Various Style Options

Now that we understand the coverage and protection offered by the three main x-ray apron styles, we can take a closer look into the unique benefits available for each apron style.

Frontal Protection

X-ray aprons offering frontal protection are available with several important features including closure options, back type and frontal aprons designed for specialty applications. Front protection x-ray aprons are available with three different closure types including buckle closure, strap closure (tie style), and velcro closure.

There are several factors you will want to consider when choosing the right x-ray apron back type including apron weight, the length of procedure, and types of procedures performed. There are a variety of x-ray apron back types to choose from including the standard plain back apron, flex back apron, back relief/support apron, and fast wrap aprons. There are several speciality options available including pregnancy aprons (1.00mm Pb equivalency over fetal area) and lap guards, lead aprons with a sewn in thyroid collar, and the quick ship lightweight lead flex guard apron.

Front and Back Protection

There are several options to choose from when looking for front and back protection including full wrap aprons and vest/skirt aprons.  Standard medical x-ray protection levels commonly available  for front/back protection aprons are offered in the following combinations:

Front Protection Pb Equivalent/Back Protection Pb Equivalent

  • 0.50mm/0.25mm
  • 0.35mm/0.25mm
  • 0.25mm/0.25mm

Full Wrap Aprons

Full wrap aprons are available in several styles including full overwrap, special procedure, and tabard styles while providing maximum protection. Full overwrap aprons provide lumbar support which reduces fatigue and upper back stress during long procedures. Vest/skirt aprons create maximum weight distribution between the shoulders and hips which eliminates stress on the upper and lower back.

Full Overwrap Protection 

The full overwrap aprons are secured via velcro straps and provides maximum radiation protection which reduces back fatigue during long procedures.

Special Procedure

Special procedure aprons have velcro seems that allow the sides of the apron to separate when bending or sitting while still maintaining front protection.

 

Tabard Style

The tabard style apron – a tabard was a short coat that men commonly wore during the middle ages – is a sleeveless, single piece apron that has a right shoulder and side velcro closure that allows for easy access.

Vest/Skirt Aprons

Vest/skirt aprons provide greater flexibility to the wearer with regard to sitting, bending, or stooping. The skirt is designed for complete overlap to provide maximum protection. Many of the vest/skirt sizes can be mixed to provide maximum comfort and fit.

Quick Drop X-Ray Apron

The quick-drop apron style is designed to be worn over the scrub suit and under the O.R. gown for quick removal without breaking the sterile field after x-ray procedures are completed. The quick-drop style aprons do not have arm holes and require assistance from a second party when putting it on or removing the apron. Quick-drop aprons are available with velcro criss-cross back flaps that assure easy removal. The Xenolite O.R. Quick-Drop Apron allows for freedom of movement, maximum flexibility, and optimal comfort.

Questions? 

Now that we have reviewed the various benefits of the core materials used in x-ray aprons, the different types of protection, and highlighted some of the main benefits of the different types of apron styles, you should be able to choose the right x-ray apron for your specific needs. If you have any additional questions, feel free to leave a comment below or contact us via live chat on our e-commerce site during normal business hours (M-F 9-5 EST).

How To Determine Which X-Ray Apron Material Is Right For You (Part 2)

In our previous post, 3 Different Types of Radiation Shielding Materials, we discussed various radiation shielding material options including standard lead (lead vinyl composition), lead composite and non-lead shielding materials. Radiation shielding garments are generally used to protect medical patients and workers from direct and secondary radiation during diagnostic imaging in hospitals, clinics and dental offices. Radiation shielding garments include x-ray aprons, vests, kilts, skirts and thyroid shields. Now that we have a better understanding of the radiation shielding options available we can apply this knowledge in choosing the right x-ray apron material for your application.

The Three Types Of Radiation Shielding Materials

The first and most well-known radiation shielding material is standard lead. Manufactured with 100% lead, standard lead x-ray aprons are the heaviest x-ray aprons available. The second radiation shielding material is a lead-based composite; lead composite x-ray aprons use a mixture of lead and other light weight radiation attenuating metals, reducing the weight by up to 25% compared to standard lead aprons. The third and final option is the non-lead or lead-free shielding material which is made from other types of attenuating metals including antimony, tungsten, bismuth and tin.

Core Material Options

The three core material options discussed all have their own unique benefits and features. There are many factors you will want to consider when making your decision on which x-ray apron material is best for you including the specific procedure being performed, length of the procedure, and the frequency of the procedure. Following the ALARA principles of time, distance and shielding your radiation safety officer or radiation physicist can evaluate the level of radiation protection required for your specific procedure.

Before we continue this discussion further, it is important to understand the terminology related to protective clothing and radiological protective materials. When choosing x-ray aprons, lead equivalency is quite possibly the most important factor to consider.

Attenuation

The definition of attenuation according to the American Society for Testing and Materials is “For radiological protective material, the reduction in the intensity of the X-ray beam resulting from the interactions between the X-ray beam and the protective material that occur when the X-ray beam passes through the protective material.”

Lead (Pb) Equivalency

The definition of lead equivalency according to the American Society for Testing and Materials is “For radiological protective material, the thickness of in millimeters of lead (commonly designated mmPb) of greater than 99.9 percent purity that provides the same attenuation as a given protective material.”

Kilovolts, Peak (kVp)

The definition of (kVp) according to the American Society for Testing and Materials is “the maximum electrical potential across an x-ray tube during an exposure, expressed in kilovolts.”

Which X-Ray Apron Material Is Right For You?

Standard Lead

Standard lead X-ray aprons are manufactured using 100% lead are the most traditional and economical option. For example, the standard large lead plain back apron (Product Code: 790RL) offers frontal protection weighing in at 11 pounds. This particular apron offers a nominal lead equivalence of 0.5mm and 100% protection at 80 kVp. Standard lead x-ray aprons are well-suited for shorter procedures. The weight of the apron will increase depending on the level and areas of protection required.

Lead Composite

Lead composite x-ray aprons are a lead-based alloy and can achieve weight reductions of up to 25% compared to standard lead x-ray aprons of the same size, style and lead equivalency. The lead composite large male Xenolite Elastic Tab Apron (Product Code: 610E) offers frontal protection weighing in at 9 pounds. This Xenolite apron offers a nominal lead equivalence of 0.50mm and 100% frontal protection at 100 kVp. This lead composite x-ray apron incorporates a two element material; the lead is blended with an additional attenuating metal and is recyclable. The lightweight and ultra-lightweight lead composite x-ray aprons are good for short to medium-length procedures.

Non-Lead

Non-Lead or Lead-Free x-ray aprons are manufactured from a proprietary blend of attenuating heavy metals. Lead is not the only metal that protects you from an x-ray beam. These heavy metals may include barium, aluminum, tin, bismuth, tungsten and titanium. The Xenolite Non-Lead Elastic Tab Apron is 40% lighter than standard lead aprons and has a 0.50mm lead equivalency and 100% frontal protection at 100 kVp. The non-lead and lead-free aprons are recyclable and safe for non-hazardous disposal and are excellent for long procedures.

(Part 3) How To Choose The Right X-Ray Apron Style 

Now that we have discussed the different types of core materials and their benefits, you should have a better understanding of what to look for when selecting your next x-ray apron or radiation shielding garment. In our next post we will discuss the different types of x-ray apron styles that are available. If you have any questions or comments,  please feel free to leave them below or connect with us on twitter!