The Use of Lead Protection for Staff in Mobile Radiographic Settings: Can Staff Abandon Its Use?
DOI:
https://doi.org/10.17140/ROJ-5-134Keywords:
Radiation protection, Occupational dose, Lead protection, Mobile radiography, Radiography, COVID-19 pandemicAbstract
The use of lead protection in patient contexts has recently come under scrutiny, with organisations moving towards ceasing its
use in plain film radiography. The use of lead shielding in protecting staff in low-dose settings, such as plain film and mobile radiography,
is therefore an important aspect of practice to be reviewed. The objective of this review is to evaluate the use of lead
shielding in protecting staff in plain film and mobile radiography, while also exploring the evolution of occupational doses and
perceptions of lead protection. While literature is limited on the use of lead protection for staff in mobile settings, lead protection
has been shown to reduce staff and adjacent patient dose from scatter. Furthermore, despite the increased frequency of medical
imaging procedures in contemporary radiography, the occupational doses of medical radiation workers have reduced over time.
With literature demonstrating gaps in current understandings of radiobiological mechanisms at low doses, the linear no-threshold
model utilised to estimate radiation risk and develop protection standards cannot be rejected. Thus, this review finds the need for
further research to be undertaken to improve risk estimates at low doses in larger cohorts of medical radiation workers, for the
demonstration of long-term effects from occupational exposure, prior to ceasing staff lead protection.
References
Brodsky A, Kathren RL. Historical development of radiation safety practices in radiology. Radiographics. 1989; 9: 1267-1275. doi: 10.1148/radiographics.9.6.2685944
Edwards M. Development of radiation protection stan-dards. Radiographics. 1991; 11: 699-712. doi: 10.1148/radiograph-ics.11.4.1887122
Preston DL, Kusumi S, Tomonaga M, et al. Cancer incidence in atomic bomb survivors. Part III: Leukemia, Lymphoma and multiple myeloma, 1950-1987. Radiat Res. 1994; 137: S68-S97. doi: 10.2307/3578893
No authors listed. The 2007 recommendations of the interna-tional commission on radiological protection. Ann ICRP. 2007; 37(2-4): 1-332. doi: 10.1016/j.icrp.2007.10.003
Linet MS, Kim KP, Miller DL, Kleinerman RA, Simon SL, Ber-rington de Gonzalez A. Historical Rreview of occupational ex-posures and cancer risks in medical radiation workers. Radiat Res. 2010; 174: 793-808. doi: 10.1667/RR2014.1
Warlow T, Walker-Birch P, Cosson P. Gonad shielding in pae-diatric pelvic radiography: Effectiveness and practice. Radiography. 2014; 20: 178-182. doi: 10.1016/j.radi.2014.01.002
Jeukens CRLPN, Kutterer G, Kicken PJ, et al. Gonad shielding in pelvic radiography: Modern optimised X-ray systems might al-low its discontinuation. Insights Imaging. 2020; 11: 15. doi: 10.1186/ s13244-019-0828-1
Winfeld M, Strubel N, Pinkney L, et al. Relative distribution of pertinent findings on portable neonatal abdominal radiographs: Can we shield the gonads? Pediatr Radiol. 2013; 43: 1295-1302. doi: 10.1007/s00247-013-2700-7
No authors listed. 1990 recommendations of the international commission on radiological protection. Ann ICRP. 1991; 21(1-3): 1-201.
Australian Society of Medical Imaging and Radiation Therapy (ASMIRT). ASMIRT Position Statement: Gonadal Shielding. Vic-toria, Australia 2020: 3.
The American Association of Physicists in Medicine (AAPM). AAPM Position Statement on the Use of Patient Gonadal and Fe-tal Shielding. Alexandria, VA, USA: AAPM; 2019.
The British Insititute of Radiology (BIR). Guidance on Us-ing Shielding on Patients for Diagnostic Radiology Application. London, UK: The British Institute of Radiology (BIR); 2020: 1-87.
Marsh RM, Silosky M. Patient Shielding in diagnostic imaging: Discontinuing a legacy practice. AJR Am J Roentgenol. 2019; 212: 755-757. doi: 10.2214/AJR.18.20508
Cheon BK, Kim CL, Kim KR, et al. Radiation safety: A focus on lead aprons and thyroid shields in interventional pain management. Korean J Pain. 2018; 31: 244-252. doi: 10.3344/kjp.2018.31.4.244
Tonkopi E, Lightfoot C, LeBlanc E. SU-F-I-72: Evaluation of the ancillary lead shielding for optimizing radiation protection in the interventional radiology department. Medical Physics (Lancaster). 2016; 43: 3403-3403. doi: 10.1118/1.4955900
Hu P, Kong Y, Chen B, Liu Q, Zhuo W, Liu H. Shielding ef-fect of lead glasses on radiologists’ eye lens exposure in interven-tional procedures. Radiat Prot Dosimetry. 2017; 174: 136-140. doi: 10.1093/rpd/ncw098
Shortt CP, Al-Hashimi H, Malone L, Lee MJ. Staff radiation Review | Volume 5 | Issue 1| Munoz C et al doses to the lower extremities in interventional radiology. Cardio-vasc Intervent Radiol. 2007; 30: 1206-1209. doi: 10.1007/s00270-007- 9071-0
McGinley P, Miner M. A history of radiation shielding of X-ray therapy rooms. Health Phys. 1995; 69: 759-765. doi: 10.1097/00004032-199511000-00010
Rolleston H. X-ray and radium protection Committee. Radiol-ogy. 1924; 3: 171-176. doi: 10.1148/3.2.171b
Boice J, Dauer LT, Kase KR, Mettler FA, Vetter RJ. Evolution of radiation protection for medical workers. Br J Radiol. 2020; 93: 20200282. doi: 10.1259/bjr.20200282
Nead KT, Mitra N, Weathers B, et al. Lower abdominal and pel-vic radiation and testicular germ cell tumor risk. PLoS One. 2020; 15: e0239321. doi: 10.1371/journal.pone.0239321
Australian Radiation Protection And Nuclear Safety Agency (ARPANSA). Code for Radiation Protection in Planned Exposure Situations. 2020. Web site. https://www.arpansa.gov.au/sites/de-fault/files/rps_c-1_rev_1.pdf. Accessed November 29, 2021.
Hayton A, Wallace A, Marks P, Edmonds K, Tingey D, John-ston P. Australian per caput dose from diagnostic imaging and nuclear medicine. Radiat Prot Dosimetry. 2013; 156: 445-450. doi: 10.1093/rpd/nct101
Yoder CR, Dauer L, Balter S, et al. Dosimetry for the study of medical radiation workers with a focus on the mean absorbed dose to the lung, brain and other organs. Int J Radiat Biol. 2018; 1-36. doi: 10.1080/09553002.2018.1549756
Chartier H, Fassier P, Leuraud K, et al. Occupational low-dose irradiation and cancer risk among medical radiation workers. Occup Med (Oxford). 2020; 70: 476-484. doi: 10.1093/occmed/kqaa130
Lee WJ, Choi Y, Ko S, et al. Projected lifetime cancer risks from occupational radiation exposure among diagnostic medical radiation workers in South Korea. BMC Cancer. 2018; 18: 1206. doi: 10.1186/s12885-018-5107-x
Preston DL, Kitahara CM, Freedman DM, et al. Breast cancer risk and protracted low-to-moderate dose occupational radiation exposure in the US Radiologic Technologists Cohort, 1983-2008. Br J Cancer. 2016; 115: 1105-1112. doi: 10.1038/bjc.2016.292
Seong KM, Seo S, Dalnim L, et al. Is the linear no-thresh-old dose-response paradigm still necessary for the assessment of health effects of low dose radiation? J Korean Med Sci. 2016; 31: S10-S23. doi: 10.3346/jkms.2016.31.S1.S10
Shore RE, Beck HL, Boice JD, et al. Implications of recent epi-demiologic studies for the linear nonthreshold model and radiation protection. J Radiol Prot. 2018; 38: 1217-1233. doi: 10.1088/1361- 6498/aad348
Boice JJD, Cohen SS, Mumma MT, Ellis ED. The million per-son study, whence it came and why. Int J Radiat Biol. 2019; 1-14. doi: 10.1080/09553002.2019.1589015
Trout E, Kelley J, Kellner J. Scattered radiation from bedside Roentgen examinations. Am J Roentgenol Radium Ther Nucl Med. 1972; 114: 832-836. doi: 10.2214/ajr.114.4.832
Grazer RE, Meislin HW, Westerman BR, Criss EA. A nine-year evaluation of emergency department personnel exposure to ion-izing radiation. Ann Emerg Med. 1987; 16: 340-342. doi: 10.1016/ s0196-0644(87)80183-x
Braun BJ, Skiendzielewski JJ. Radiation exposure of emergency physicians. Ann Emerg Med. 1982; 11: 535-540. doi: 10.1016/s0196- 0644(82)80426-5
Chiang H-W, Liu Y-L, Chen T-R, Chen C-L, Chiang H-J, Chao S-Y. Scattered radiation doses absorbed by technicians at different distances from X-ray exposure: Experiments on prosthesis. Biomed Mater Eng. 2015; 26: S1641-S1650. doi: 10.3233/BME-151463
Longo M, Genovese E, Donatiello S, et al. Quantification of scatter radiation from radiographic procedures in a neonatal in-tensive care unit. Pediatr Radiol. 2018; 48: 715-721. doi: 10.1007/ s00247-018-4081-4
Fernández R, Moreno-Torres M, Contreras AM, Núñez MI, Guirado D, Peñas L. Patient and staff dosimetry during radio-graphic procedures in an intensive care unit. J Radiol Prot. 2015; 35: 727-732. doi: 10.1088/0952-4746/35/3/727
Elshami W, Abuzaid MM, Tekin HO. Effectiveness of breast and eye shielding during cervical spine radiography: An experi-mental study. Risk Manag Healthc Policy. 2020; 13: 697-704. doi: 10.2147/RMHP.S257185
Perdomo A, McMahon S, Wilkie T, Fox N, Rao P. Do carers and comforters require lead aprons during general radiographic examinations? J Med Imaging Radiat Oncol. 2021; In press: 1-9. doi: 10.1111/1754-9485.13304
Hayre CM, Bungay H, Jeffery C. How effective are lead-rubber aprons in protecting radiosensitive organs from secondary ionizing radiation? Radiography (Lond). 2020; 26: e264-e269. doi: 10.1016/j. radi.2020.03.013
Hung M-C, Chang P. Increased lead concentrations in the hairs of radiographers in general hospitals. Sci Rep. 2021; 11: 236. doi: 10.1038/s41598-020-80721-3
Burns KM, Shoag JM, Kahlon SS, et al. Lead aprons are a Submit your article to this journal | https://openventio.org/submit-manuscript/ lead exposure Hazard. J Am Coll Radiol. 2017; 14: 641-647. doi: 10.1016/j.jacr.2016.10.024
Shoag JM, Michael Burns K, Kahlon SS, et al. Lead poisoning risk assessment of radiology workers using lead shields. Arch Environ Occup Health. 2020; 75: 60-64. doi: 10.1080/19338244.2018.1553843
Abuzaid MM, Elshami W, Shawki M, Salama D. Assessment of compliance to radiation safety and protection at the radiology department. Iranian journal of radiation research (IJRR). 2019; 17: 439- 446. doi: 10.18869/acadpub.ijrr.17.3.439
Mohd Ridzwan SF, Bhoo-Pathy N, Isahak M, Wee LH. Per-ceptions on radioprotective garment usage and underlying reasons for non-adherence among medical radiation workers from public hospitals in a middle-income Asian setting: A qualitative explora-tion. Heliyon. 2019; 5: e02478. doi: 10.1016/j.heliyon.2019.e02478
Heo Y, Chun H, Kang S, Lee W, Jang T, Park J. Relating factors to wearing personal radiation protectors among healthcare profes-sionals. Ann Occup Environ Med. 2016; 28: 60. doi: 10.1186/s40557- 016-0144-x
Hayre CM, Blackman S, Carlton K, Eyden A. Attitudes and perceptions of radiographers applying lead (Pb) protection in gen-eral radiography: An ethnographic study. Radiography (Lond). 2018; 24: e13-e18. doi: 10.1016/j.radi.2017.07.010
Chan J, Auffermann W, Jenkins P, Streitmatter S, Duong P-A. Implementing a novel through-glass chest radiography technique for COVID-19 patients: Image quality, radiation dose optimiza-tion, and practical considerations. Curr Probl Diagn Radiol. 2022; 51(1): 38-45. doi: 10.1067/j.cpradiol.2020.12.003
Rai A, MacGregor K, Hunt B, et al. Proof of concept: Phan-tom study to ensure quality and safety of portable chest radiogra-phy through glass during the COVID-19 pandemic. Invest Radiol. 2020; 56: 135-140. doi: 10.1097/RLI.0000000000000716
Brady Z, Scoullar H, Grinsted B, et al. Technique, radiation safety and image quality for chest X-ray imaging through glass and in mobile settings during the COVID-19 pandemic. Phys Eng Sci Med. 2020;43:765-779. doi: 10.1007/s13246-020-00899-8
Medial Radiation Practice Board of Australia (MRPBA). Pro-fessional capabilities for medical radiation practitioners. Australia. 2020: 1-17.
Clement C, Ruehm W, Harrison J, et al. Keeping the IRCP recommendations fit for purpose. J Radiol Prot. 2021; In press: doi: 10.1088/1361-6498/ac1611
Published
How to Cite
Issue
Section
License

This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in Radiology (ROJ) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.