Lead Aprons in Radiology: Are They Still Necessary?

Radiography Roadmap • Published on March 28

The use of lead aprons in radiology has been a long-standing practice aimed at minimizing radiation exposure. However, evolving research and updated guidelines from organizations like the American College of Radiology (ACR) and the American Association of Physicists in Medicine (AAPM) have led to a reevaluation of their necessity in certain scenarios. While patient shielding may not always be required, protective measures remain crucial for radiologic technologists and specific procedures.

What the Experts Say

  • Updated Guidelines: The ACR and AAPM recommend against routine patient shielding, including gonadal and fetal shields, during diagnostic imaging. Studies have shown that these shields provide little to no benefit and may actually interfere with image quality.
  • Increased Radiation Exposure from Repeats: If any part of valuable anatomy is clipped or obscured by the shielding, the image must be repeated, leading to significantly higher radiation exposure than if shielding had not been used at all.
  • Patient Safety and Dose Optimization: Modern imaging equipment is designed to minimize radiation exposure, and the focus has shifted toward optimizing radiation dose through technology rather than physical shielding.

When Lead Aprons Still Matter

While patient shielding is no longer a routine necessity, lead aprons remain important for individuals who are in the room but not undergoing imaging. This includes:

  • Family Members or Visitors: If a patient has a roommate, family member, or visitor who cannot or will not leave during the procedure, they should be provided a lead apron for protection.
  • Nurses and Healthcare Staff: In cases where nurses or other staff must remain in the room—such as during portable X-rays in hospital rooms or when assisting with patient care—they should wear appropriate shielding.
  • Technologists Holding Patients: If a technologist or another staff member must physically support a patient during imaging, especially in pediatric or trauma cases, wearing a lead apron is essential to minimize occupational exposure.
  • Operating Room (OR) Procedures: During fluoroscopy or C-arm use in the OR, surgeons, anesthesiologists, nurses, and technologists are exposed to scattered radiation. Lead aprons, thyroid shields, and in some cases, leaded glasses remain critical for protection in these settings.
  • Pediatric Imaging Considerations: While shielding is generally not recommended, careful case-by-case assessment is important when imaging children.

While shielding practices have evolved for patients, protecting those who are regularly or inadvertently exposed to radiation remains a priority in maintaining workplace safety.

What This Means for Imaging Professionals

  • Adapting to New Standards: Facilities are transitioning to updated radiation protection policies, and technologists should stay informed about current best practices.
  • Patient Education: Many patients are accustomed to lead aprons and may express concerns when they are not provided. It’s important to communicate why shielding is no longer routine and how modern technology reduces risks. However, if a patient requests shielding even after the explanation, their preference should be respected. Arguing with the patient can cause unnecessary delays and frustration, negatively impacting their experience. Instead, calmly comply with their request to ensure they feel comfortable and reassured during the procedure.
  • Workplace Implementation: The ACR encourages institutions to develop individualized policies that align with evidence-based research while ensuring staff and patient confidence in radiation safety.

Final Thoughts

The conversation around lead aprons in radiology is evolving, with a growing emphasis on dose optimization rather than outdated shielding practices. While lead protection is no longer necessary for routine patient shielding, it remains vital in specific scenarios like surgical procedures and staff protection in high-exposure environments. As the field of radiology advances, staying informed and adapting to best practices ensures both patient safety and professional well-being.

For further reading on this topic, check out the official ACR guidelines here: https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/radiology-safety/radiation-safety




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