How to Choose the Right X-Ray Apparel
Medical X-rays, C-arms, and fluoroscopy emit significant doses of scatter radiation that are harmful to clinicians exposed to it regularly. For example, information from the National Institutes of Health states that ongoing medical radiation exposure may increase the risk of cancer, skin damage, cataract development, and more.
The CDC states that following ALARA (as low as reasonably achievable) guidelines is essential to reduce those risks. That includes minimizing time near the radiation source, staying as far away from radiation beams as possible, and wearing personal protective equipment (PPE) like a lead apron or thyroid shield.
Proper shielding using PPE is especially important in high-dose procedures like C-arm guided fluoroscopy, where clinicians operating near the ray radiation for an extended duration may be unavoidable.
What X-ray apparel do you need? We’ll cover what you should know in this guide, including how to choose the right protective garments, who to consult for guidance, and how to maintain them so they’re as effective as possible. Keep reading for all the details.
What Are the Best Clothes to Wear for an X-Ray?
There are several types of PPE that clinicians can wear above their medical scrubs to shield against scatter radiation when using X-rays, C-arms, and fluoroscopy. Those include:
Lead Aprons
When clinicians are looking for the best clothes for X-ray shielding, radiation protection aprons are an essential component. A lead apron will hang from the shoulders down to just above the knees to protect crucial organs like the breasts, gonads, heart, and lungs.
A study from the Journal of Clinical Orthopedic Trauma found that 0.5 mm lead aprons can attenuate up to 99% of scatter radiation.
Thyroid Shields
A study in the European Journal of Radiology stated that the thyroid gland is one of the most sensitive organs to radiation. Even regular low-dose exposure can harm the thyroid. Therefore, wearing a thyroid shield that wraps around the neck to protect it is another essential piece of X-ray protective thyroid shield.
A study published in the Korean Journal of Pain revealed that thyroid shields can reduce radiation exposure by a factor of 2.5. Meanwhile, research from the Spine Orthopedic Journal reported even greater protection, showing that snug-fitting traditional lead thyroid shields can lower radiation doses by approximately 8.5 times.
Lead Glasses or Full Lead Visor
A review published in 2020 stated that the eyes are highly sensitive to radiation. Ongoing exposure in radiology or interventional surgery can lead to adverse health outcomes like cataracts, optic neuropathy, glaucoma, and retinopathy. Therefore, shielding the eyes during high-dose procedures is another crucial part of radiation safety.
Ray protective glasses, such as lead glasses or a full lead visor can provide effective eye protection. Research from Physica Medica found that lead glasses could reduce the radiation dose to the eyes by approximately 1.6 times, and a full lead visor could reduce the dose by 4.5 times.
What Not to Wear During an X-Ray
The Mayo Clinic states that eyeglasses, jewelry, and other metal objects can appear on X-rays, causing artifacts. Therefore, having patients remove any objects that would obscure the image is essential to ensure quality.
Furthermore, the CDC mentions that anything with buttons, buckles, or zippers would be inappropriate clothing for X-rays since the metal on those would also interfere with the image.
Facilities will often provide a medical gown for patients to wear that doesn’t have any materials that would reduce the image’s quality.
Should Patients Wear Protective Garments During X-Rays?
Having patients wear radiation safety apparel like lead shielding in the field of view of the X-ray usually isn’t recommended. A study from the Journal of Medical Imaging and Radiation Sciences stated that wearing high-density lead shielding in the field of view can reduce the image’s quality and may increase the radiation dose.
Additionally, a study in the British Journal of Radiology mentioned a growing body of research suggesting that patients wearing lead garments during X-rays may be unsafe. It’s a result of modern X-rays using automatic controls to increase exposure. When a patient wears lead shielding in the field of view, the machine will increase the beam’s intensity to make it through the high-density garments. It significantly increases the radiation dose to the whole room. Patient protection strategies should be determined in consultation with the facility’s RSO and align with the latest regulatory guidance.
In general, the risk to patients from a single X-ray is low. For example, the American Cancer Society states that the average chest X-ray emits 0.1 mSv of radiation.
However, it’s still recommended for clinicians conducting regular X-ray procedures to wear garments for radiation protection, like lead aprons and thyroid shields. Even lower doses of 0.1 mSv will add up quickly for medical staff members conducting X-rays frequently.
Furthermore, clinicians wearing protective garments won’t interfere with image quality since they aren’t in the way of the direct and secondary radiation beams.
Factors to Consider When Choosing X-Ray Apparel
There are several factors to consider during X-ray garment selection, including:
Comfort and Fit
Garments should fit snugly—secure enough to provide protection but not so tight that they cause discomfort. A proper fit is essential. For instance, research from Spine found that wearing a snug-fitting lead thyroid shield, compared to a loose one, reduced radiation doses by an additional 19%.
Garments should also be well-fitted with appropriately sized necklines, armholes, and shoulder panels to ensure adequate coverage for the clinician’s body type.
Thickness
PPE like lead aprons, thyroid shields, and glasses come in varying thicknesses based on their lead equivalence. Intense, high-dose procedures may require thicker garments to provide appropriate shielding.
Commonly recommended thicknesses for different types of PPE are:
Lead aprons: The Journal of Clinical Orthopedic Trauma states that standard lead aprons should be at least 0.5 mm thick. However, some clinicians may opt for thinner 0.25-0.35 mm options during low-dose X-rays. Additionally, some thicker 1.0 mm maternity lead aprons may be used to provide extra protection.
Thyroid shields: A study from the Korean Journal of Pain states that thyroid shields should be at least 0.5 mm thick to provide sufficient protection.
Lead glasses: The same study from the Korean Journal of Pain also stated that lead glasses should be 0.5-0.75 mm thick, which can attenuate up to 95% of scatter radiation.
It’s best to consult your facility’s radiation safety officer to ensure you choose protective garments with the ideal thickness for each procedure.
Material
Lead is often used for protective garments because of its high density, which slows and absorbs X-rays and gamma rays before they reach the wearer’s body. However, some alternative high-density materials are rising in popularity and use in medical settings.
Common alternative materials include:
Bismuth
Barium
Tungsten
Tin
Antimony
These materials are generally lighter than lead, so clinicians may opt for lead-free aprons to reduce fatigue when wearing protective garments for extended periods of the day.
Benefits of Lead-Free Aprons
Generally, lead-free aprons have two primary benefits that make them stand out:
Weight: As mentioned, weight is one of the key benefits of lead-free aprons. A study in 2018 found that lead-free options can reduce apron weight by 25%. Lightweight apparel is helpful to reduce fatigue and boost comfort for clinicians who are on their feet throughout the day.
Environmental impact: The European Journal of Radiology stated that lead-free aprons are generally more environmentally friendly, making them easier to recycle and dispose of at the end of their lifespan.
However, that same study from the European Journal of Radiology found that lead-free options aren’t the best for every procedure. Researchers found that lead-free alternatives provide similar protection to traditional lead at intensities below 90 kVp, but traditional lead performed slightly better at intensities above 90 kVp. This suggests that the ideal material depends on the specific procedure being performed. Clinicians should always consult with their Radiation Safety Officer to select the appropriate material and thickness for each procedure, ensuring both safety and comfort.
How to Ensure X-Ray Garment Quality
The first step to ensure garment quality is to purchase all PPE from reputable manufacturers who use good materials and effective production processes. To give you a quick buyer’s guide, both Burlington Medical and Techno-Aide produce top-notch lead aprons, thyroid shields, and other protective garments.
However, just buying high-quality X-ray apparel isn’t enough. You also must maintain your protective garments so they remain as effective as possible throughout their lifespan. That includes:
Performing annual X-ray inspections
Repairing any damage identified
Deep cleaning and disinfecting garments regularly
Protective garments like lead aprons and thyroid shields will accumulate wear and tear during regular use. A study by the Journal of Health Physics showed that damage can accumulate rapidly, with small tears increasing by up to 270% in 10 months. Damage to PPE can reduce its effectiveness, so it’s essential to inspect all garments using X-ray scanning annually to detect even small pinholes and make necessary repairs as soon as possible.
Additionally, protective garments can accumulate dirt, germs, and contaminants in medical settings. A study from Dr. Jaber that cultured 25 lead aprons in a medical facility found that 84% harbored Tinea species (ringworm) and Staphylococcus aureus, and 12% were contaminated with MRSA. These findings support what we've observed in the field—wipes and sprays alone are not enough to remove resilient pathogens like MRSA or ringworm. Professional deep cleaning is necessary for health and safety.
Conclusion
Wearing the appropriate X-ray apparel, such as lead aprons, thyroid shields, and glasses, is essential to protect clinicians who are regularly exposed to harmful scatter radiation. Ultimately, the right apparel to choose depends on the type of procedure and individual needs. Consulting with your facility’s radiation safety officer can ensure that you make effective choices.
It’s also important to maintain your protective garments so they stay clean, effective, and safe. We can help with that step at Radiological Care Services (RCS).
How RCS Can Help with Protective Garment Maintenance
Protective garment maintenance and management is often time-consuming and costly for busy medical facilities. We can help you manage it at RCS to reduce stress and ensure compliance with high-quality standards. Our services include:
Annual inspections using X-ray scanning
Garment repairs
Deep cleaning and disinfection
Garment disposal
Inventory management with our RADCOMPLY™ software
Our services follow recommendations from governing bodies like the CDC and AORN for compliance and effectiveness.
Contact us today to learn more about how RCS can make a difference for you.