What Are the 4 Types of PPE for Radiation Protection?
Personal protective equipment (PPE) is an essential part of radiation safety in healthcare. PPE such as lead aprons is capable of blocking and absorbing radiation before it reaches the wearer’s body, which is essential for healthcare workers frequently exposed while using equipment like C-arms and fluoroscopy.
While researching the types of protective garments, you may see some resources mention 4 types of PPE and feel unsure what they’re referring to or which is best for your team.
What are the 4 levels of PPE? We’ll review the different types of radiation PPE in this article and specific garments that are frequently used in healthcare settings to help you make educated choices for your facility and occupational safety.
Introduction: Why Is PPE Important in Healthcare?
PPE is a crucial component of healthcare safety because of how often workers in radiology are exposed to radiation and the health risks of exposure when proper shielding isn’t used.
Clinicians in radiology are frequently exposed to radiation while using equipment like C-arms and fluoroscopy. AORN stresses the need for safety precautions while using C-arms since the average C-arm emits 20 mSv (2 rem) of radiation per minute. Additionally, the FDA states that fluoroscopy emits relatively high doses of radiation that require proper protection.
When radiation exposure isn’t managed properly, it can lead to several adverse health outcomes. The World Health Organization (WHO) states that occupational exposure above dose limits recommended by governing bodies like OSHA can increase the risk of cancer, tissue damage, blood damage, cataracts, and infertility.
Fortunately, radiology personal protective equipment use can significantly reduce occupational exposure levels. For example, a study from the Journal of Clinical Orthopedic Trauma states that 0.5 mm lead aprons can attenuate up to 99% of scatter radiation and recommends that they’re used for safety during interventional procedures using C-arm guided fluoroscopy.
What Are the Four PPE Categories for Radiation? (PPE Levels A, B, C, D)
OSHA and the EPA classify PPE under four categories (labeled A-D) for varying levels of exposure. You may also hear these referred to as PPE levels 1 to 4, although the letters A, B, C, and D are the proper names for each level under the OSHA and EPA guidelines. Each category goes as follows:
Level A: Provides the highest level of protection. Level A often includes wearing a fully encapsulated suit with a self-contained breathing apparatus (SCBA). This level is used the most when working in close proximity with hazardous substances, and isn’t typically required in radiology settings.
Level B: A step down from Level A with less skin protection. It usually involves wearing chemical-resistant clothing and an SCBA. This level is best to protect against airborne contaminants, and is rarely used in radiology.
Level C: Uses a powered air purifying respirator (PAPR) and splash protective clothing. It’s best in environments that require skin protection or when airborne contaminants are present. Level C is also rarely used in radiology.
Level D: The most common in radiology and other medical settings. Level D focuses on wearable garments that shield against ionizing radiation emitted from imaging equipment. Common types of garments used include lead aprons, thyroid collars, glasses, and gloves.
PPE Level D: The Standard for Radiology and Surgery
The National Institutes of Health states that Level D PPE is the best when airborne hazards aren’t present and the risk of contact with hazardous substances is low.
In healthcare, the biggest risk of radiation exposure is X-rays and gamma rays emitted during diagnostic imaging like fluoroscopy. Lead aprons and thyroid shields are well-suited to shield against that type of radiation. The high density of lead effectively slows and absorbs X-rays and gamma rays before they reach the wearer’s body.
Additionally, this level of shielding is flexible and light enough so healthcare workers can bend and move around during interventional procedures. Higher levels of protection, such as the fully encapsulated suit in Level A, would make it much harder to make precise movements required for surgery.
What Types of PPE Are Used for Radiation in Healthcare?
There are many common types of PPE in healthcare that fall under Level D shielding. Here are some common options to consider while building your facility’s radiation safety equipment list:
Lead aprons: Lead aprons are one of the most common types of shielding used in radiology. They hang from the shoulders down to just above the knees, protecting crucial organs like the breasts, heart, lungs, and reproductive organs. A study from the Journal of Radiography found that lead aprons could attenuate 98-99.9% of ionizing radiation.
Thyroid collars: A thyroid collar wraps around the neck to shield the thyroid gland, which is highly sensitive to radiation. A study from Spine found that lead thyroid collars worn snug around the neck could reduce radiation doses by 8.5 times.
Lead glasses: Lead glasses shield the eyes, which are often highly exposed to radiation when operating right next to fluoroscopic tubes. A study from Physica Medica indicated that 0.75 mm lead glasses reduced radiation doses to the lens of the eyes by 1.6 times.
Vests and skirts: Two-piece vest and skirt sets are a common alternative to lead aprons meant to reduce fatigue by evenly distributing the weight of the garments at the shoulders and waist. Research from the Journal of Clinical Orthopedic Trauma showed that 0.5 mm lead vest and skirt sets performed as effectively as 0.5 mm lead aprons.
Factors in Choosing the Right PPE for Radiation Safety
Some of the main factors to consider when choosing PPE are the exposure time, radiation intensity, and type of procedure. The EPA states that higher intensities and longer exposure times require equipment with a greater shielding capacity.
OSHA states that consulting with your facility’s radiation safety officer (RSO) is best to determine the types of shielding and thicknesses that are right for each procedure.
OSHA also mentions that healthcare workers should wear personal dosimeters to monitor exposure levels and make adjustments to safety precautions as needed to remain under recommended dose limits.
Maintenance and Inspection of Radiation PPE
PPE maintenance is another important aspect to manage to ensure garments remain in top condition throughout their lifespan. That includes PPE inspection, repairs, and deep cleaning and disinfection.
We recommend annually inspecting your PPE using X-ray scanning. A study from Radiography Open stated that cracks, holes, or tears in garments can reduce their shielding capabilities, so it’s important to identify and repair damage early. Lead apron inspections using X-ray scanning can help identify small damage before it gets out of control.
AORN also recommends quarterly deep cleaning for all high-touch objects in medical settings, including PPE like lead aprons. PPE used in medical settings can have high contamination rates. For instance, a study from Dr. Jaber of Wayne State showed that 84% of lead aprons analyzed were contaminated with Tinea species (ringworm) and Staphylococcus aureus.
We can help with all your PPE maintenance needs at Radiological Care Services (RCS) to ensure your garments remain safe and effective long-term.
Conclusion: Best Practices and Additional Resources
PPE is essential in medical settings to shield against radiation emitted from equipment used in diagnostic imaging and interventional surgery. It’s a good idea to consult with your RSO to determine appropriate shielding needs for each procedure and continuously monitor the effectiveness of your safety policies.
We can help you maintain radiation protection best practices at RCS by sourcing PPE from top manufacturers and helping you efficiently handle maintenance needs.
Our core maintenance services include:
Deep cleaning and disinfection
Inspections using X-ray scanning
Garment repairs
Garment disposal
Inventory management with our RADCOMPLY™ software
Contact us today to learn more about how RCS can make a difference for you.