Letters to the Editor: Letter to the Editor
To the Editor
Did you know that no regulatory organization—including the Occupational Safety & Health Administration —has specific guidelines regarding inspection and safety criteria for lead aprons? In fact, only the Joint Commission provides recommendations to annually inspect lead aprons but does not offer inspection or rejection criteria, instead leaving specific guidelines to the state and institutional level.1 The Health Physics Society further recommends those aprons that do not pass the physical inspection should be examined under fluoroscopy.2,3 Some hospitals like the Mayo Clinic in Jacksonville, FL do just that.
Despite these recommendations, there are institutions where the only safety measure consists in feeling the lead apron for cracks annually. This may not be sensitive enough to pick out small cracks, which is important because current radiation safety guidelines suggest disposing of lead shields if the sum of the cracks is greater than 15 mm2 in aprons or 11 mm2 in thyroid shields.4 Hospitals that do not perform qualitative checks of lead aprons with fluoroscopy state that doing so is an unnecessary exposure to the technicians and an unnecessary cost. Wearing your personal radiation badge will show your total radiation exposure, but is not preventative because it will not detect a damaged apron.5–7
If this is the state of affairs in your hospital, then we recommend that you insist that all lead aprons be dated as to when they were bought and last checked, that you choose the “newest” apron available, and that you encourage all of your colleagues to hang up their lead after use to prolong longevity.
James Tan, MD
John G. Brock-Utne, MD, PhD
Department of Anesthesia
Stanford University School of Medicine
1. Joint Commission on Accreditation of Healthcare Organizations. Accreditation Manual for Hospitals, Environment of Care Section 1.6. 2001 Chicago, IL Joint Commission on Accreditation of Healthcare Organizations
3. Michel R, Zorn M. Implementation of an X-ray radiation protective equipment inspection program. Health Phys. 2002;82(2 Suppl):S51–3
4. Lambert K, McKeon T. Inspection of lead aprons: criteria for rejection. Health Phys. 2001;80:S67–9
5. Ismail S, Khan F, Sultan N, Naqvi M. Radiation Exposure to Anaesthetists During Interventional Radiology Anesthesia. Anaesthesia. 2010;65:54–60
6. Ismail S, Khan FA, Sultan N, Naqvi M. Radiation exposure of trainee anaesthetists. Anaesthesia. 2006;61:9–14
7. Henderson KH, Lu JK, Strauss KJ, Treves ST, Rockoff MA. Radiation exposure of anesthesiologists. J Clin Anesth. 1994;6:37–41