Will Science Finally Help Solve the Problem of X-Ray Lead Aprons?

Some hospitals have now stopped draping x-ray patients with lead aprons after medical professionals labeled it as simply a ‘feel good’ measure.

Although many patients expect to have their organs covered during an x-ray procedure, new studies have revealed that the decades-old practice could impair the quality of diagnostic tests.

The new measure is intended to improve the quality of care, but it is thought that hospitals will have to work hard to prove to regulators, and more importantly the public, that it is safe.

The movement has yet to gain traction among dentists, who perform more than half of all X-rays. Of the 595 million medical X-rays performed in America in 2016, 320 million were dental X-rays.

Rebecca Marsh, a medical physicist at the University of Colorado Anschutz Medical Campus in Aurora, Colorado, addressed an audience at the annual meeting of the Radiological Society of North America.

She said: “There’s this big psychological component, not only with patients but with staff.

“How do you approach something that is so deeply ingrained in the minds of the health care community and the minds of patients?”

Covering the testicles and ovaries during X-ray procedures is a practice that has been around since the 1950s when studies conducted on fruit flies raised concerns that radiation during the scans could cause harm to the human body.

It has only been in the past decade that researchers have started to look into the routine and reassess how it is carried out based on changes in imaging technology in the modern-day.

However, medical professionals from the American Association of Physicists in medicine now claim that the lead aprons are difficult to position, so they may be missing the area they’re supposed to cover anyway.

It’s also thought that these covers could mask important information from doctors, such as a swallowed object, which would result in having another X-ray.

Shields could perhaps even cause automatic exposure controls on X-ray machines to increase the radiation sent out in a bid to ‘see-through’ the lead cover.

Covers do not protect against ‘scatter’ exposure, either, which occurs when radiation ricochets inside the body and deposits itself in tissues, including those that are ‘protected’ by shields.

The amount of radiation needed for an X-ray is now around one-twentieth of what it was in the 50s, and no measurable harm has ever been found to those who were exposed to today’s levels of radiation.

Dr. Donald Frush, a radiologist at Lucile Packard Children’s Hospital Stanford in Palo Alto, California, who chairs the Image Gently Alliance, added there is likely no hereditary risk at all. No studies have ever suggested a fetus could be harmed from exposure.

Dr. Cynthia Rigsby, a radiologist at Chicago’s Ann & Robert H. Lurie Children’s Hospital, has called the move a ‘pretty substantial’ change, adding that she doesn’t think it’s going to happen ‘overnight’.

The move to stop the use of aprons started in April 2019 when the association sent out its recommendation to discontinue use as ‘routine practice’.

The American College of Radiology and the Image Gently Alliance promoted the message and the FDA proposed removing a recommendation in the Federal Code to use shielding.

A final ruling on the change is not expected until September 2020.

The National Council on Radiation Protection and Measurements is also expected to release a statement in the coming year supporting the halt to patient shielding.

Rebecca Marsh added that movements are underway in Canada, Australia, and the UK to support the change and around six American hospitals have changed their policy, although ‘most hospitals are starting to have the conversation’.

She said technologists will need support in educating the public on the topic ‘so they are not feeling like they are walking into a disastrous conversation’. Chicago’s Lurie hospital is now launching an ‘Abandon the Shield’ campaign before it stops shielding in Spring. Currently, the hospital uses shields in around 70,000 of its X-ray procedures annually.

Dr. Kate Feinstein, chief of pediatric radiology, told KHN that the recommendation to stop shielding ‘came as kind of a shock’, adding that it seems contrary to what radiology professionals are initially taught.

Feinstein added she’s uncertain how the ruling will apply to her department, which already takes steps to ensure shielding doesn’t hinder procedures.

“We apply our shields correctly, and our technologists are incredibly well trained,” she said.

She did say, however, that her department is currently weighing a halt to routine shielding.

Hospitals are concerned about violating state regulations. At least 46 states, including Illinois, require reproductive organs to be shielded by law unless it interferes with the diagnostic quality of the exam.

While a number of states are now revising their regulations, some hospitals have applied for waivers or have started to take the stance that shields have the ability to hinder the quality of X-ray scans whenever they are used.

Healthcare professionals are prepared for those who may still insist on shielding: the physicians’ group suggested hospitals take into account that some patients may want to be shielded for ‘calm and comfort’.

The American Dental Association already has guidelines surrounding shielding- saying it ‘may not be necessary’ but continues to recommend dentists use lead collars to protect the thyroid ‘whenever possible’.

However, Mahadevappa Mahesh, chief medical physicist at Johns Hopkins Hospital, said dentists haven’t been approached much on the topic and it is ‘high time’ they are brought into the discussion.

Mahesh, who is also a board member of the physicists’ association, cautioned that collars to protect the thyroid may obscure images taken by newer 3D dental imaging machines.

Advice from the Association is now under review. For now, all health care workers in the imagery room of both dental surgeries and hospitals have been recommended to continue wearing leaded barriers in the interest of occupational safety.

The annual meeting of the Radiological Society of North America plans to discuss changes in both diagnostic radiology and radiation oncology.