Why is a thyroid collar not recommended for patient shielding in panoramic radiography?
The American Dental Association (ADA) updated its X-ray shielding guidelines in February of 2024, stating that using a lead apron or thyroid shield during X-rays is no longer necessary. Afterward, there’s been some confusion in the medical and dental world about what’s needed to protect sensitive organs like the thyroid gland.
Why isn’t a thyroid collar recommended in panoramic dental radiographs? Is it still required for other medical uses? We’ll provide a complete overview here to help you make educated choices for the safety of patients and clinicians.
Are Thyroid Shields Safe for Radiation Protection?
After hearing that the ADA no longer recommends using thyroid collars in dental X-rays, you may be wondering whether they are safe to use.
Thyroid collars are safe and beneficial for protecting the thyroid gland during high-dose radiation procedures.
The American Thyroid Association states that shielding, such as thyroid collars, is safe and recommended for procedures emitting high radiation doses, such as C-arm-guided fluoroscopy in interventional surgery.
A study published in the Korean Journal of Pain also stated that shielding, such as thyroid shields and lead aprons, is a fundamental safety measure for protecting critical organs from scatter radiation in interventional surgery.
Lastly, another study from the Journal of Radiation Physics and Chemistry said that thyroid shielding is safe and effective for medical X-rays.
Therefore, while thyroid shielding isn’t recommended for dental X-rays, there are still many thyroid collar uses in medical settings where higher doses of radiation are emitted.
Is Using Thyroid Collars During Radiographic Exams No Longer Recommended by the ADA?
The statement published by the ADA in February 2024 states that thyroid collars are no longer needed for dental X-rays, such as panoramic radiographs, when using modern equipment that’s properly calibrated. Modern dental X-rays emit much lower doses of radiation, so exposure risks are minimal during quick panoramic imaging.
The International Atomic Energy Agency (IAEA) states that the average modern dental X-ray emits 1-8 μSv (0.001-0.008 mSv) per image, and panoramic exams emit 4-30 μSv (0.004-0.030 mSv). Those doses are much lower than older dental radiographs used to emit, which is why reports of dental X-rays and thyroid problems like hypothyroidism or dental X-rays and thyroid cancer have gone down.
However, proper shielding is still necessary in many medical settings. For instance, AORN states that the average C-arm emits a radiation dose of 2 rem (20 mSv) per minute, making wearing shielding like lead aprons and thyroid collars essential.
What Four Items Do Patients Need to Remove if Present Before Exposure to a Panoramic Radiograph?
A study in the International Journal of Dentistry recommended removing eyeglasses, necklaces, earrings, and dentures before taking a dental panoramic radiograph. These objects can cause artifacts (also called ghost images) in panoramic X-rays, reducing the image’s clarity.
The ADA also mentioned that patients wearing thyroid shields during panoramic X-rays could have a similar effect since it could block the primary X-ray beam. Therefore, it’s another reason why they don’t recommend thyroid collars for dental X-rays.
Which Type of Radiographic Projection Requires the Use of a Thyroid Collar?
Many interventional surgery or diagnostic imaging procedures require clinicians to wear proper shielding like thyroid collars or lead aprons. Medical X-rays, C-arms, and fluoroscopy all emit radiation doses that can harm the thyroid gland with ongoing exposure.
The American Cancer Society states that a single chest X-ray emits about 0.1 mSv of radiation, and a mammogram emits 0.4 mSv. It’s significantly higher than dental X-rays and can add up fast for clinicians performing imaging procedures throughout the day. Therefore, an X-ray thyroid collar can be a good idea for clinicians in medical settings.
Additionally, the FDA states that fluoroscopy emits relatively high doses of radiation, and AORN states that the average C-arm emits 2 rem of radiation per minute. Therefore, using proper shielding, such as lead aprons and thyroid collars, is essential for clinicians performing C-arm guided fluoroscopy.
Shielding may also be used to protect patients. However, it varies on a case-by-case basis since clinicians must ensure it doesn’t interfere with the procedure.
Protective Garments Must be Maintained to Ensure Safety
Wearing protective garments like thyroid collars and lead aprons will protect against harmful scatter radiation in high-dose medical procedures. However, it’ll accumulate wear and tear, dirt, germs, and contaminants with long-term use. Medical facilities must maintain protective garments to keep their staff and patients safe.
We recommend conducting annual X-ray inspections to identify and repair cracks, holes, and tears that accumulate. A study by Radiography Open stated that such damage may reduce the effectiveness of protective garments. Another study by the Journal of Health Physics also found that even small damage can progress rapidly, with small tears increasing by up to 270% in 10 months.
We also recommend deep cleaning and disinfecting garments quarterly. Lead aprons and thyroid collars can harbor harmful microorganisms when not properly cleaned. For instance, a study by Dr. Jaber that analyzed 25 lead aprons found that 84% were contaminated with Tinea species (ringworm) and Staphylococcus aureus, and 12% were contaminated with MRSA.
Keep Your Protective Garments Clean and Effective with Our Services at RCS
At Radiological Care Services (RCS), we can help ensure that your facility’s garments remain clean, safe, and effective. Our services include:
Deep cleaning and disinfection
Annual inspections using X-ray scanning
Garment repairs
Garment disposal
Inventory management with our RADCOMPLY™ software
We know deep cleaning, inspecting, and repairing garments in-house can be time-consuming and costly, so we’re here to provide a more efficient solution. All you have to do is send your garments to us, and we’ll handle the process with care while following regulations from governing bodies like the CDC and AORN.
Contact us today to learn more about how RCS can help.