November 17, 2008

Lead Aprons — New Software and Tag System Organizes Record Keeping
By Annie Macios
Radiology Today
Vol. 9 No. 23 P. 36

Thanks to its mundane nature, managing lead aprons often lingers on the imaging director’s to-do list. Too often, there is no straightforward method for completing the time-consuming task. From keeping track of the lead aprons in a facility, ensuring they are in proper condition, and preparing for state and Joint Commission equipment inspections to ultimately disposing of lead aprons that have passed their prime, imaging staff must be diligent when ensuring these important items are present and accounted for—and in safe condition to use.

While a seemingly minor piece of imaging equipment in comparison to CT and MRI machines, lead aprons play the vital role of protecting physicians, imaging staff, and patients from unnecessary radiation exposure during diagnostic radiology procedures. To keep this equipment in proper order and to verify its maintenance, standards set forth by The Joint Commission dictate that healthcare organizations must perform routine inspections on lead aprons, just as they must do with other devices, equipment, and supplies.

Because The Joint Commission does not dictate inspection frequency, method, or rejection criteria for lead apron management, facilities are left to establish their own policies and procedures.

Typically, a facility will perform an annual inspection of each apron, depending on state regulations. Costing roughly $125 to $300 apiece, it is important that lead aprons be kept in good condition for as long as possible. Tracking inspection information, however, has been difficult at best because lead aprons are used in various departments throughout a facility and are often tracked through unreliable, tedious methods.

“Managing lead aprons appropriately enables hospitals and imaging centers to keep the aprons in the best condition possible and also be prepared for any state or Joint Commission inspections. An apron management program doesn’t have to be expensive; it can be implemented for around the cost of two angio aprons,” says Mike Ruthemeyer, RT(R)(M)(QM), CEO of, a Houston-based company that provides lead apron management software.

When imaging departments were smaller and more centralized, managing lead aprons was less of a hassle: Simply find the apron, inspect it, then log it on a paper register. As imaging centers and departments grew increasingly larger, it became more difficult to keep track of the lead aprons.

Many methods of tracking have been used, but they offer varying degrees of success. For example, tracking information can be written on an apron’s inspection tag, but the tags often fall off or are illegible. It’s also possible to add new tags or write directly on the aprons, but these present the possibility of damage.

ApronCheck, a product of Macro Niche Software, Inc, provides a simple yet reliable way of managing lead apron inventory, making it possible to be ready for inspections at a moment’s notice. By attaching uniquely numbered, tamper-resistant “buttons” to each apron with color-coded inspection indicators that are changed yearly, knowing which aprons have been inspected is easier.

Another issue, according to Ruthemeyer, is that state or Joint Commission inspectors arrive unannounced and request the latest inspection reports. Applications such as Microsoft Word, Excel, and Access can handle the task but require users to develop their own systems, often resulting in only marginal lead apron inspection reports. ApronCheck software provides a detailed place to track inspection information for each apron, including specific information regarding the condition of each apron or when and how the apron was removed from a facility. It also can track privately owned aprons to create an inspection history for every apron in a facility.

Using a drop-down menu, inspection data can be entered, and 18 different reports can be generated, including those for inspection dates, missing aprons, and privately used aprons, with the information accessible for posting to a department’s Web site. By knowing the status of each apron with the click of a button, imaging departments can act accordingly to ensure that all aprons are accounted for and in good condition.

“This technology offers easy data entry to organize and report lead apron tracking information,” says Ruthemeyer, who adds that the software is continually being enhanced to include suggestions made by users.

To smooth the transition from a paper to electronic lead apron tracking system, offers an extensive Web-based tutorial that enables a facility to become versed in the technology before the software arrives. “It takes you through various scenarios regarding tracking issues, so when the software arrives, a facility can get up and running with it much more easily,” Ruthemeyer adds.

Jack Estrada, RT(R)(CT), director of diagnostic imaging at the 253-bed St. Joseph Hospital in Bellingham, Wash., was frustrated with the manual paper process and hassle involved in tracking the status of the lead aprons throughout his facility. That frustration changed to relief at an AHRA meeting a few years ago when he met Ruthemeyer.

“I was talking with Mike about the hassle of having to depend on paper records or writing on aprons with a pen to keep track of the last inspections. It was very frustrating. Mike mentioned that he had the software available to track lead aprons more efficiently, which I was pleased to hear, and St. Joseph Hospital became a beta site user for the technology,” says Estrada.

Ruthemeyer worked with Estrada to implement ApronCheck software at the facility. After a few tweaks over the years, the system has significantly reduced the hassle of this task. Now Estrada keeps track of all the facility’s lead aprons in one place and knows exactly how many are in the system and when they were last inspected. “All the information is in one place, and there is no writing on new aprons, which tends to look unprofessional and is undependable. When The Joint Commission or Department of Health [and Human Services] asks about the care and management of our aprons, we can go to the computer and instantly produce a report instead of having to look things up manually in the quality assurance log,” says Estrada.

During a recent Joint Commission inspection, Estrada says officials seemed satisfied with the data provided in the ApronCheck report and did not pursue additional information.

Having used ApronCheck over the last 11/2 years, Estrada says he enjoys the fact that everything is organized in one place, and it is no longer a chore for staff to keep track of the aprons. “We previously did the data collection on paper, and nobody would want to do it because it was such a chore to first find the aprons, write the status, and manually log the information on paper. Changing to ApronCheck enabled us to put the system in place very quickly, so now our lead apron management system is no longer a chore that nobody wants to do,” says Estrada.

By managing lead aprons appropriately, it is easier to establish when a lead apron is no longer functional for everyday use. To determine usability, the Health Physics Society suggests physically examining all lead aprons for gross defects such as tears, perforations, and thinning creases and removing those with defects from use.

In addition, the remaining aprons should be examined fluoroscopically using a manual setting and low technique factors, keeping in mind that shielded areas will appear dark, and defects, seams, and stitching will appear light. Again, defective aprons should be removed and disposed of properly.

“With reimbursement either remaining the same or decreasing while the workload increases, healthcare facilities have to find new ways to reduce costs, and improving efficiency is one way to do so. Having a sound lead apron management system in place and using the available technology can help achieve this,” says Ruthemeyer.

— Annie Macios is a freelance writer based in Doylestown, Pa.

Disposing of Unusable Lead Aprons
What do you do with an apron once it’s determined that it’s no longer usable?

According to the Health Physics Society, lead and other heavy metals meet the criteria for a hazardous material under the Resource Conservation and Recovery Act; therefore, they must be disposed of in an appropriate manner. Healthcare facilities have several options for disposing unusable lead aprons, including the “green” option of recycling.

“Lead aprons can be treated as hazardous material or be recycled as such. If treated as hazardous material, they are disposed of and become waste. By recycling the lead, they go back into use and have a better environmental impact,” says Bill Jansen, president of MetalQuest in Cincinnati, which provides lead apron disposal services.

MetalQuest began as a materials recovery firm that recycled precious materials. “We’d often get lead aprons included among the other materials, and although we weren’t in the lead apron disposal market at the time, it was a service we would provide,” says Jansen.

He noticed that while there were waste disposal companies available where facilities could dispose of lead aprons, no real service was available to combine with a lead apron management program. So MetalQuest introduced its lead apron disposal program that not only enabled facilities to safely dispose of their lead aprons but also certified that the apron had been recycled and issued the participating facility an environmental impact statement.

In addition, the facilities that use the program are given a recycling offset credit offered through RecycleNet Corporation, which provides a certified measurement system to recognize and reward companies for their recycling efforts and can be used to calculate an equivalent of a participant’s offset of its carbon footprint. Recycling offset credits can be redeemed from RecycleNet Corporation for a certificate verifying the facility’s recycling achievements.

Jansen says the lead apron disposal program is designed to make recycling hazardous lead aprons an easy venture for healthcare facilities and imaging centers by arranging for containment and shipping. Upon request, MetalQuest provides an appropriately sized barrel to meet a facility’s disposal needs, and once filled, it is picked up at the facility with no extra steps taken by the imaging staff.

In today’s focus on “going green,” recycling lead aprons is an environmentally friendly option that earns a facility recycling offset credits. But beyond that, it lets the community know that the facility is doing its part to help the environment. “It’s a straightforward program and is truly green with no strings attached,” says Jansen.

— AM