Radiation Safety In Healthcare: What Medical Professionals Need to Know
Medical professionals who regularly conduct diagnostic imaging, interventional surgery, and other essential procedures are frequently exposed to ionizing radiation emitted by the equipment involved—an exposure classified as occupational radiation exposure for frontline radiation workers.
The World Health Organization (WHO) estimates that more than 37 million nuclear medicine procedures, 7.5 million radiotherapy treatments, and 3.6 million diagnostic radiology exams are conducted worldwide each year. That adds up to a lot of radiation exposure for clinicians and is why the WHO stresses the need for robust radiation protection measures in healthcare.
What protocols can facilities use to keep health workers safe, and how much radiation is considered acceptable? We’ll discuss the recommendations from governing bodies and current research in the rest of this guide to help you make educated decisions.
Introduction To Radiation Safety
The National Institutes of Health (NIH) states that equipment that uses ionizing radiation has become an inescapable tool for diagnosing and treating various medical conditions. Equipment like C-arms and fluoroscopy is highly accurate and useful, but as its use increases, so do exposure levels for personnel who handle radioactive material or high-dose imaging systems every day.
Radiation safety protocols and education about the effects of occupational radiation are necessary to balance safety and effectiveness. The right guidelines keep medical professionals safe while operating in high-dose environments and confident in their choices for their health and well-being and reduced cancer risk.
Radiation Doses Emitted During Interventional Surgery
The NIH states that fluoroscopy accounts for the most exposure in gamma radiation–producing interventional radiology settings. You’ll often see C-arm guided fluoroscopy used for real-time imaging during interventional procedures.
The U.S. Environmental Protection Agency (EPA) states that a single fluoroscopic procedure can emit between 1.5 and 57 mSv of radiation. AORN also states that the average C-arm emits 2 rem (20 mSv) of radiation per minute.
Radiation Dose Limits From Governing Bodies
The OSHA standard for radiation exposure to the full body is 1.25 rem (12.5 mSv) per quarter or 5 rem (50 mSv) per year. Additionally, the International Commission on Radiological Protection (ICRP) recommends an average annual radiation dose limit of 20 mSv, with no single year exceeding 50 mSv. Therefore, a few minutes of exposure during C-arm guided fluoroscopy without safety measures could exceed the recommended limits.
Why Radiation Safety For Healthcare Workers Is Essential
Information from the NIH shows that exceeding recommended dose limits can lead to adverse health effects like increased risk of cancer, damage to the lens of the eye, and skin damage or burns. This can even occur in low-dose medical settings when healthcare workers are frequently exposed, such as routine medical imaging like X-rays.
Therefore, proper radiation safety protection, such as wearing lead personal protective equipment (PPE), is essential for occupational safety in medical settings.
What Are The Three Basic Rules Of Radiation Safety?
The 3 basic principles of radiation protection are: time, distance, and shielding. They come from the CDC’s guidelines for ALARA (as low as reasonably achievable). ALARA is meant to guide medical teams on ways to minimize exposure for staff and patient safety as much as possible. The 3 rules go as follows:
Time: Operate as efficiently as possible to reduce exposure times. A study from the Journal of Clinical Gastroenterology and Hepatology showed that taking time to educate healthcare workers about radiation best practices reduced fluoroscopy times by 30-50%. However, some lengthy procedures can’t be avoided, so other safety measures are still crucial.
Distance: Standing farther from the radiation source reduces exposure. AORN recommends clinicians stand 6 feet away from the radiation source when possible, but notes that physicians operating right next to equipment during interventional surgery may be unavoidable, so other measures like shielding are required for safety.
Shielding: Wearing PPE like lead aprons, glasses, and thyroid shields can protect crucial organs from ionizing radiation. A study from the Journal of Clinical Orthopedic Trauma states that a 0.5 mm lead apron can attenuate up to 99% of ionizing radiation during medical procedures.
What Radiation Safety Precautions Should Healthcare Workers Be Aware Of?
Several precautions for radiation safety and protection can help healthcare workers remain safe while working in high-dose environments. Those include:
Wearing PPE For Shielding
One of the most significant radiation safety precautions is wearing appropriate shielding for each procedure. The most common shielding material is lead because of its high density. When X-rays or gamma rays come into contact with lead PPE, it can slow and absorb their energy before they reach the wearer’s body.
As mentioned, managing aspects like time and distance can help, but they aren’t always possible during every procedure. Some interventional procedures will last for hours or require surgeons to operate right next to the radiation source. Therefore, wearing protective garments that shield against radiation would be the best way to manage doses received.
Implementing Operating Techniques To Reduce Radiation Doses
The International Atomic Energy Agency (IAEA) lists several fluoroscopic techniques that could help reduce radiation doses during applicable procedures, such as:
Using pulsed fluoroscopy to break up X-ray beams and exposure into shorter bursts.
Setting pulse rates on equipment as low as possible based on the type of procedure.
Use high-dose rate modes on equipment cautiously and only when deemed medically necessary.
These techniques don’t replace wearing shielding and won’t apply to every procedure, but they can make a difference for staff and patient safety when used at appropriate times. Always consult your facility’s Radiation Safety Officer (RSO) and your team before making any changes to your standard protocol.
Consulting With Your Facility’s Radiation Safety Officer
OSHA recommends that healthcare facilities develop and implement a radiation protection program with the guidance of a qualified radiation safety officer (RSO). An RSO is usually a health physicist or has completed a rigorous certification program to implement safety standards, ensure compliance, manage equipment, and resolve incidents effectively.
OSHA also mentions developing a full radiation safety committee as an alternative. The RSO would be the head of the committee, while other experts throughout the facility would be chosen to assist during essential decision-making.
Either way, the RSO is a knowledgeable professional that facilities should turn to for guidance about safety equipment, strategies, and precautions for each procedure. They will help you make educated choices that keep your staff and patients safe.
Radiation Safety Equipment List
The most common types of PPE that help with radiation safety for healthcare workers are:
Lead Aprons
Lead aprons hang from the shoulders to just above the knees. They protect crucial organs like the breasts, lungs, heart, and gonads.
You may see them come in frontal or wraparound styles. The Association of Surgical Technologists recommends that clinicians wear wraparound lead aprons during procedures where physicians frequently turn their backs to the radiation source.
Several studies show that lead aprons are highly effective, such as the one mentioned before from the Journal of Clinical Orthopedic Trauma and one published by Heliyon. Both showed that 0.5 mm lead aprons can attenuate up to 99% of radiation.
Lead Vests And Skirts
Two-piece lead vests and skirt sets provide an effective alternative to traditional lead aprons with added comfort
One of the problems some medical workers will find with lead aprons is their weight. A study published by JVS Vascular Insights mentioned that the average 0.5 mm lead apron weighs 5-7 kilograms (approximately 11-15 pounds). It’s a significant amount to have supported by the shoulders alone during extended procedures.
Therefore, the two-piece lead vest and skirt set can help split the weight evenly between the shoulders and the waist. A study from PLOS One showed that two-piece radiation protection effectively reduced weight pressure and shoulder fatigue.
Thyroid Shield
The thyroid gland is one of the most sensitive organs in the body to radiation. The thyroid shield is a garment that wraps around the neck to provide essential protection.
A study from the Korean Journal of Pain recommended wearing a thyroid guard while using C-arms and fluoroscopy. Research from the European Journal of Radiology also recommended thyroid shielding during low-dose procedures to reduce the effects of repeated exposure.
Thyroid shields are highly effective. A study published by Spine showed that a lead thyroid collar worn snug around the neck during C-arm fluoroscopy could reduce radiation doses by approximately 8.5 times.
Lead Glasses Or Full Lead Visor
The eyes are another organ that’s highly sensitive to radiation. A review published in 2020 showed that frequent exposure to the lens of the eyes could lead to adverse health effects like cataracts, glaucoma, retinopathy, or optic neuropathy.
Lead glasses or a full lead visor are wearable protective measures that can help. A study from Physica Medica showed that 0.75 mm lead glasses reduced radiation doses to the eyes by 1.6 times, and a full lead visor reduced doses by 4.5 times.
What Can A Healthcare Professional Do To Limit Their Exposure To Radiation?
Radiation safety precautions that healthcare professionals can use to limit exposure are:
Using PPE Appropriately
A study in 2018 from the Korean Journal of Pain outlined several ways that healthcare professionals can ensure the PPE they wear is as effective as possible. That included:
Making sure garments fit properly, such as along the armholes, neckline, and across the body, for lead aprons. Any large gaps that don’t cover the body could increase exposure levels. The study also mentioned inspecting PPE regularly to identify damage that could affect the garment’s fit or effectiveness.
Wearing a thyroid shield whenever the neck is exposed to radiation and ensuring it fits snugly to prevent gaps that would increase exposure.
Handling lead aprons and other garments carefully. Avoid folding them or storing them near pointed objects, since it could cause damage that reduces their effectiveness. Instead, keep them hanging when not in use. You can also lay them flat or roll them like a beach towel during transport.
Implementing Procedural Changes To Reduce Exposure
The FDA lists several procedural changes healthcare teams can make to minimize exposure and risk for staff and patients, such as:
Adjusting equipment to administer the lowest radiation dose that still yields good image quality.
Ensure any referrals for imaging are justified and necessary to make medical decisions.
Consider alternative methods of diagnosis or examination that don’t use equipment that emits radiation when possible.
Check the patient’s medical history carefully to avoid duplicate imaging.
Regularly review procedures, effectiveness rates, and new research to make necessary adjustments and ensure all best practices are being followed based on current information available.
Educating Staff On Radiation Safety Measures
The FDA also emphasizes that medical staff members should receive training on radiation safety and continuing education whenever regulations or guidelines change.
A survey conducted in 2016 found that only 39% of physicians report receiving radiation safety education. Therefore, proper training is often lacking in medical facilities.
However, when proper training is given, it can improve safety and reduce radiation exposure substantially. For example, a study in 2014 showed that real-time coaching on appropriate positioning during C-arm fluoroscopy reduced radiation doses that physicians received by approximately 50%.
What Are The Government Regulations For Radiation Safety In Healthcare?
One of the main government guidelines for radiation safety in healthcare is following the principles of ALARA mentioned earlier. Governing bodies like the EPA and the CDC recommend minimizing exposure time, standing further from the radiation source when possible, and using shielding like lead protective garments.
Additionally, OSHA sets regulations for the maximum radiation dose medical workers should receive. The maximum quarterly radiation doses permitted by OSHA are:
1.25 rem to the full body
18.75 rem to the hands, forearms, feet, and ankles
7.5 rem to the skin of the whole body
Implementing X-Ray Safety Precautions For Patients
The IAEA recommends several X-ray safety precautions for patients during fluoroscopy. Those guidelines include:
Know your equipment and ensure staff members are trained to use it safely.
Keep the X-ray tube as far from the patient as possible while still being able to obtain a quality image.
Keep records of exposure time for each patient.
Use the lowest frame rate possible that still provides consistent image quality.
Be aware that lateral views and oblique projections can increase patient doses.
Avoid using a large field of view or magnification.
Vary the beam's position when appropriate to avoid irritating the same part of the skin.
Should Patients Wear PPE?
It usually isn’t recommended for patients to wear PPE like lead aprons or thyroid shields during diagnostic imaging or interventional procedures.
One of the reasons for that is that studies, such as one from the Journal of Medical Imaging and Radiation Sciences, show that wearing lead garments in an X-ray’s field of view can reduce image quality.
The British Journal of Radiology also mentions a growing body of research showing that wearing lead garments in the field of view of modern imaging equipment can cause safety risks.
The automatic controls on modern X-ray equipment try to calculate the radiation dose required based on factors like the patient’s weight and size. The high density of lead PPE would cause those controls to turn the dose all the way up, increasing exposure to the entire room.
Conclusion And Future Directions
Following the guidelines from governing bodies outlined in this article will help your medical practice stay on the right track for staff and patient safety while operating equipment that emits high doses of radiation.
It’s important to consult with your organization’s radiation safety officer for best practices and continue optimizing and reviewing research for the best results.
Additional Considerations For Health And Safety While Using PPE
Another consideration when using PPE regularly during medical procedures is that it must be cleaned and inspected regularly to minimize health risks and ensure top functionality.
A growing amount of research is showing that PPE, such as lead aprons and thyroid shields, has high contamination rates.
For example, a study conducted by Dr. Jaber of Wayne State showed that 84% of lead aprons analyzed were contaminated with Staphylococcus aureus and Tinea species (ringworm), and 12% were contaminated with MRSA.
AORN’s 2025 guidelines for perioperative practice also state that PPE like lead aprons, thyroid shields, vests, and skirts have high contamination rates between 62.5% and 100%.
We recommend regular deep cleaning and disinfection for all garments to remove harmful pathogens and prevent adverse health effects like hospital-acquired infections that can occur with contaminated garments.
Additionally, we recommend inspecting garments annually to identify and repair damage like cracks or tears that can reduce a garment’s effectiveness. A study from the Journal of Health Physics showed that even small damage can progress by up to 270% in 10 months, so acting early is essential to prevent it from getting out of hand.
How We Help With Protective Garment Maintenance At RCS
Our team at Radiological Care Services (RCS) is here to help you keep your protective garments clean, inspected, and maintained to extend their lifespan and ensure they’re as effective as possible.
Our services include:
All our services follow guidelines from governing bodies like the CDC and AORN to ensure high effectiveness rates.
Contact us today to learn more about how RCS can help you keep your PPE in top condition for staff and patient safety.