Dose Safety: Radiation Shielding’s Evolution
By Rebekah Moan
Radiology Today
Vol. 26 No. 5 P. 26
Radiation shielding has evolved. For a long time, the only way to shield people from scatter radiation was to wear a lead apron that could weigh up to 25 lbs, and even that wasn’t a perfect solution as there were gaps in the arms, hands, and head that were still exposed. Now, solutions such as lead-free wearables, creams, and shields reduce radiation exposure while also cutting out the musculoskeletal injuries that arose from wearing lead shields.
Candace Vernon, the senior product manager at Burlington Medical, notes that while the company still sells lead aprons, hardly anyone buys those products anymore. “It’s probably less than 1%,” she says. Instead, customers are buying a lead-free, lightweight, flexible, and recyclable x-radiation protection material that uses a mixture of two attenuating elements, antimony and tungsten, in a mixture optimized for minimum area-weight and maximum attenuation in the key diagnostic imaging range of 80 to 100 kv.
Aprons are not a perfect fit, unless they’re tailored and customized, so in addition to offering that service, Burlington Medical sells breast, axilla, and thyroid coverage. These wearables are designed to reduce the risk of breast cancer and other radiation- associated cancers in health care professionals.
Studies show that people who are frequently exposed to scatter radiation have a higher risk of developing cancers of all types. Maria Grazia Andreassi, PhD, and colleagues reported in an April 12, 2016, study in Circulation: Cardiovascular Interventions that people in these environments have three times the risk of cancer.
That increased cancer risk, especially of breast cancer, is something Julia Jacobson, the president and CEO of BLOXR Solutions, is attentive to. Oftentimes, lead aprons are designed with men in mind, or they’re touted as “one-size- fits-all,” but that means there are large, gaping arm holes exposing breast tissue and thus increasing breast cancer risk. “Female protection is frequently neglected,” Jacobson says. “But women need different protection, and more women are entering the medical field each year.”
Protection for women means creating bra inserts and pregnancy shields that provide an additional 0.5 mm lead equivalency. Instead of lead, all BLOXR garments are a lightweight bilayer constructed of barium sulfate and bismuth oxide. These products are able to add double the radiation protection without doubling the weight.
Orthopedic Concerns
It’s not only cancer risk that increases for health care workers in these environments—it’s also musculoskeletal problems. The same Circulation study found seven times the risk of orthopedic problems in health care workers who work in scatter radiation environments when compared with health care workers not exposed to radiation.
Bob Foster, chief medical officer and founder of Rampart IC, is intimately familiar with orthopedic problems. He was a triathlete in peak physical health and one of the nation’s highest-volume interventional cardiologists when he suffered a second ruptured disk. That injury caused a month-long paralysis in one of his legs and left him out of the cath lab for two years.
“I was in my early 50s and not ready to retire,” he says. “But I knew I couldn’t wear a lead apron anymore because that would just lead to another injury.”
Together with a team of designers and engineers, Foster created a fully adjustable and portable system that provides fullbodied radiation protection for doctors and their technologists, when used as instructed (including lower table lead curtains), without the need for lead aprons.
Rampart’s shields are made of clear, 1-mm lead-equivalent, bismuth-infused acrylic panels, allowing a clear view of the area being scanned while providing radiation protection. The panels are engineered using an acrylic formula infused with bismuth, a nontoxic and stable element. Rampart has a variety of products, but they all block radiation as close to the source as possible with the shields, and this results in greater than 99% reduction in scatter radiation, according to a study published in the Journal of the Society for Cardiovascular Angiography & Interventions in January 2024 by John Lisko and colleagues. This protection was found to be 20 times better at blocking whole-body radiation than the standard protection of a lead apron and a headshield.
“This creates more mobility and ease of use around the room,” Foster says. “Doctors and technologists can move around without the added weight of a lead apron.” But there was more to it than that—Foster also wanted a comprehensive solution for everyone in the room, not just the operator. As previously noted, lead aprons don’t fit everyone properly—there are gaps and body parts that remain uncovered—and not every health care institution budgets for customization. With shielding products such as Rampart’s, they don’t have to because they’re providing head-to-toe shielding, protecting the often-overlooked neck, head, arms, and legs.
“The ALARA (As Low As Reasonably Achievable) principle has changed with the advancement of these innovative radiation barriers that not only block almost all the radiation, but also protect the whole body, the whole team, and will likely mitigate the orthopedic risks that me, my colleagues, and our talented teams are suffering,” Foster says.
Ongoing Need
Even with advancements in room shielding, Jacobson doesn’t see personal protective gear going away, particularly because interventional radiologists are exposed to scattered radiation during C-arm fluoroscopy procedures. “They need to have tactile ability but still want to protect themselves,” she says. That’s where ULTRABLOX X-Ray Attenuating Hand Cream can be useful. The X-ray hand cream can be applied directly to the skin or encapsulated between two pairs of surgeon’s gloves.
ULTRABLOX is a bismuth oxide hand cream that’s nontoxic and water-based. “Health care providers can protect themselves more than with lead gloves and maintain their tactile ability with just one tube of cream,” Jacobson says.
It’s taken a while, but the medical field is finally making strides in protecting workers against radiation. “I met a woman who said 10 years ago she was talking about this topic, and no one was doing anything about it,” Vernon says. “She’s happy to see it’s finally getting some attention.”
— Rebekah Moan is a freelance journalist and ghostwriter based in Oakland. Her specialties are health care and profiles.
