Lead Vests

Lead vests are radiation protective garments worn in medical settings to protect clinicians from scatter radiation emitted by equipment like X-rays, C-arms, and fluoroscopy. A lead vest will cover the torso to protect crucial organs like the breasts, lungs, and heart that are sensitive to radiation. 

You may hear the terms “lead vests” and “lead aprons” used interchangeably since they serve a similar purpose. However, there is a difference between the two. 

A traditional lead apron is a single garment that hangs from the shoulders down to just above the knees. 

Alternatively, a lead vest only covers the torso. Lead vests are typically worn in two-piece vest and skirt protective garment sets. The vest covers the torso, while the skirt (or kilt) covers the upper part of the legs and reproductive organs. 

Medical staff members may opt for a two-piece set because it helps reduce fatigue. Protective aprons are heavy, and having all the weight hanging from the shoulders can cause excessive physical strain. Therefore, some clinicians opt for the two-piece vest and skirt to distribute the weight between the shoulders and the waist. 

A study from PLOS One showed that wearing two-piece radiation protection effectively reduces weight pressure and shoulder fatigue. 

Many clinicians in radiology or medical imaging are regularly exposed to scatter radiation in procedures like interventional surgery using C-arm-guided fluoroscopy. AORN states that the average C-arm emits 2 rem (20 mSv) of radiation per minute. 

Wearing proper X-ray protection is necessary to meet radiation safety standards set by governing bodies like OSHA. The OSHA standard for occupational radiation exposure to the whole body is 1.25 rem (12.5 mSv) per quarter. Therefore, just one minute of C-arm use without wearing protective garments could exceed that amount and result in unnecessary radiation exposure.  

OSHA sets that standard because ongoing occupational radiation exposure correlates with several health and safety risks. The National Institutes of Health states that healthcare workers regularly exposed to radiation could have an increased risk of cancer, tissue damage, cataract formation, and several other adverse health effects. 

Garments like lead vests and lead shield aprons are essential in X-ray shielding. The high density of lead makes it effectively slow and absorb X-rays and gamma rays emitted from medical equipment. A study from the Journal of Clinical Orthopedic Trauma showed that 0.5 mm lead aprons or two-piece vest and skirt sets can attenuate up to 99% of scatter radiation. 

Please consult your Radiation Safety Officer for your facility’s policies on radiation protective garments and equipment.

There’s minimal risk of lead exposure with well-maintained lead vests. The protective material inside the internal layer of the vest is covered by a durable outer layer that often consists of a combination of rubber and nylon. Therefore, the wearer isn’t exposed to lead while wearing the vest since the outer layer provides a barrier. 

However, significant cracks, holes, or tears in the vest could increase the risk of exposure. A study published in Radiography Open also mentioned that such damage can reduce the garment’s shielding capabilities. Regular maintenance is a key component of radiation shielding safety to prevent this and keep your staff and patients safe. 

We recommend annual inspections using X-ray scanning to detect minor damage and apply necessary repairs before it gets out of control. Even small damage can progress quickly. A study published in the Journal of Health Physics showed that small tears in lead garments increased by up to 270% in 10 months, so regular inspections must be taken seriously. 

Radiographic inspections are the most accurate way to detect damage. A study in 2018 from the Indian Journal of Radiology and Imaging emphasized the importance of regular radiographic scanning for lead garments since it provides much more precise detection of small pinholes than visual or tactile inspections. 

Facilities can still use visual and tactile inspections between annual scans to detect any major damage requiring immediate attention. However, visual and tactile scans still don’t replace the accuracy of radiographic inspections, which are essential for identifying hidden defects.

Lead vest maintenance includes proper storage, annual inspections, and quarterly deep cleaning. 

Storage is an essential component of X-ray garment care. A common storage mistake is folding garments, like lead vests, when they aren’t in use. A study in the Journal of Diagnostic and Interventional Radiology that assessed 85 lead aprons found that:

• 68.2% of the aprons were defective

• 16.5% had folds in the internal lead layer that would lead to damage over time

• Only 15.3% were structurally sound

The research indicated that a primary issue was improper storage, including folding the garments. 

Instead, the most effective option is to hang garments like lead vests and aprons on sturdy storage racks. You can also lay them flat or roll them like a beach towel during transport, ensuring they aren’t bunched or creased. 

Additionally, regular cleaning is essential for protective garments as they can build up dirt, germs, and contaminants in medical environments. A study by Dr. Jaber of Wayne State that assessed 25 lead aprons found that 84% were contaminated with Staphylococcus aureus and Tinea species (ringworm), and 12% were contaminated with MRSA. 

AORN recommends quarterly deep cleaning for high-touch objects to prevent the buildup of harmful contaminants. At RCS, we consider lead vests, aprons, and thyroid shields to be high-touch PPE and have developed a multi-step deep cleaning process in response. Our process uses an EPA-approved cleaning agent applied with friction, followed by thorough disinfection.

Finally, we recommend annual inspections using X-ray scanning for all protective garments. X-ray inspections will detect any small damage early that may not be visible. If damage is detected, we can help you perform necessary repairs or safely dispose of garments following EPA-approved protocols if repairing them isn’t possible. 

X-ray garment pricing can vary depending on the manufacturer, materials, and customization options. 

To give you some examples of average lead vest costs, regular 0.5 mm lead vests at Burlington Medical start at $312 and can range up to around $400, depending on the size and customization options applied. Burlington Medical also offers lightweight lead vests that cost more, with 0.5 mm lightweight vests averaging around $550 to $600 with minimal customization. 

Comparatively, the average 0.5 mm regular lead vest at Techno-Aide is $330, but costs increase with larger sizes or extra customization. Additionally, their 0.5 mm lightweight lead vest with minimal customization averages around $470. 

You can work with us at RCS to source lead vests from high-quality manufacturers based on your budget and facility’s needs. 

The CDC’s radiation protection standards recommend that clinicians follow ALARA (as low as reasonably achievable) guidelines during procedures that use equipment emitting scatter radiation, such as X-rays and interventional surgery with C-arm guided fluoroscopy. 

ALARA consists of three primary principles: time, distance, and shielding. That entails:

• Time: Working to operate as efficiently as possible to minimize the length of exposure. 

• Distance: Maintaining a safe distance from the radiation source when possible. AORN recommends remaining at least 6 feet from the radiation source when the procedure and operating area allow it. However, procedures like interventional surgery using fluoroscopy often require clinicians to operate right next to the radiation source. 

• Shielding: Wearing personal protective equipment (PPE) like lead vests and skirts, aprons, thyroid shields, and glasses to provide essential shielding. 

X-ray shielding guidelines and the type of protective garments necessary can vary by procedure. Therefore, it’s essential to consult with your facility’s radiation safety officer to determine the proper protective measures. 

In February 2024, the American Dental Association (ADA) updated its lead apron recommendations for dental X-ray safety. The updated guidelines state that PPE like lead vests, aprons, and thyroid shields are no longer necessary as long as dental offices are using modern X-rays that are properly calibrated. 

Modern dental X-rays emit much lower levels of radiation than they used to. Therefore, it significantly lowers the risks of exposure while briefly capturing an image. 

However, shielding is still essential for clinicians in medical environments where the equipment used often emits much higher radiation doses. 

For instance, the FDA states that fluoroscopy emits relatively high doses of radiation during interventional surgery, and AORN states that the average C-arm emits 20 mSv of radiation per minute. Any procedures using that equipment would require shielding to keep clinicians safe while performing several procedures throughout the week. 

When you hear about lead apron usage declines, it’s likely in dentistry. The American Dental Association’s updated guidelines for X-ray shielding state that lead aprons are no longer required since modern dental X-rays emit much lower radiation levels than they once did. 

However, that statement doesn’t apply to the medical field. Many medical procedures use equipment that emits higher radiation doses that can become dangerous to clinicians regularly exposed without proper radiation protection. Governing bodies like AORN still recommend clinician shielding like lead vests and aprons in medical procedures for health and safety. 

We recommend annual lead apron inspections using X-ray scanning for X-ray equipment safety. A study in 2018 indicated that regular radiographic scans of protective garments are the best way to identify minor damage that may not be visible. Identifying small damage early ensures it doesn’t get out of hand and keeps protective garments as effective as possible.  

Medical teams can also perform regular visual and tactile inspections in between annual inspections to identify any obvious damage, such as: 

• Cracks

• Holes

• Tears in the seams

• Frayed fabric

• Damaged buckles or velcro

Any damage you can see or feel should immediately be reported and repaired. 

However, it’s important to note that while visual and tactile inspections can help, they don’t replace detailed annual inspections.  Contact RCS today to schedule your annual lead vest inspections or to source high-quality radiation protective garments for your facility.