Lead shielding in radiology refers to the use of lead or lead-lined materials to block radiation exposure that clinicians are exposed to regularly. Shielding is a crucial part of the principles of ALARA (as low as reasonably achievable) recommended by the CDC and other governing bodies. Healthcare workers often use radiation protection while operating equipment such as X-rays, C-arms, and fluoroscopy that emit radiation during use. 

There are many types of shielding devices you may see in use in healthcare facilities. A common option is lead shield aprons that drape from the shoulders to just above the knees. Lead aprons protect crucial organs, such as the heart, lungs, breasts, and reproductive organs. 

Additionally, you may see clinicians use other types of lead shields for X-rays that provide additional protection to other exposed areas of the body, such as thyroid shields, gloves, glasses, or mobile lead barriers. To meet the diverse requirements of medical facilities, we also provide radiation shielding solutions tailored for both structural and personal protection.

The high density of lead allows it to slow and absorb radiation before it reaches clinicians wearing protective garments or standing behind mobile barriers. Several studies show that lead shielding is highly effective, including: 

• Research from the Journal of Clinical Orthopedic Trauma found that 0.5 mm lead aprons, vests, or skirts could attenuate up to 99% of radiation. 

• A study published in Spine found that a snug lead thyroid collar could reduce radiation doses to the thyroid gland by approximately 8.5 times. 

• A study from the Korean Journal of Pain found that 0.5-0.75 mm lead glasses could attenuate up to 95% of radiation. 

• Research published in BMJ Open found that mobile lead barriers in combination with other PPE, such as lead aprons and thyroid collars, significantly reduced radiation doses while performing extended procedures using fluoroscopy. 

Based on that data, shielding is highly effective and worthwhile for many procedures in radiology that could otherwise put healthcare workers at risk when regularly exposed to radiation. 

When you hear that lead shielding isn’t used anymore, it’s likely referring to regulation changes in dentistry. 

In February 2024, the American Dental Association (ADA) updated its guidelines, stating that lead aprons and thyroid collars were no longer necessary for dental X-rays when offices use modern equipment that’s properly calibrated. Modern dental X-rays emit much lower radiation doses than pose less risk when capturing a quick image. 

However, that change doesn’t apply to medical procedures using equipment that emits much higher radiation doses. 

For example, research from AORN showed that the average C-arm emits 2 rem (20 mSv) of radiation per minute. AORN emphasizes the importance of adhering to the ALARA principles, including the use of lead shielding, to ensure the safety of healthcare workers during C-arm-guided procedures. 

The FDA also states that fluoroscopy emits relatively high radiation doses and recommends using shielding for occupational safety. 

When making important radiation safety decisions, you should consult with your facility’s radiation safety officer (RSO) to ensure the appropriate type of shielding is used during each procedure. 

The three types of shielding in radiology are: 

1. Primary shielding: Fixed lead shield walls fall under the primary shielding category. These are structural barriers built into medical imaging rooms to shield clinicians from radiation. However, some procedures, such as interventional surgery using C-arm fluoroscopy, require the physician to operate right next to the radiation source, so fixed walls aren’t the only solution you need to reduce exposure. 

2. Secondary shielding: Mobile lead shields fall under secondary shielding. They can act as an additional layer of protection during unpredictable or extended procedures. A study from the International Atomic Energy Agency showed high effectiveness rates using them as an additional protective measure. Facilities can also use lead shield anchors to hold mobile shields in place in operating rooms. 

3. Personal protective equipment (PPE): PPE refers to all wearable shielding, such as lead aprons, thyroid collars, glasses, gloves, vests, and skirts. The CDC recommends selecting PPE based on the needs and risks associated with each procedure. Your facility’s RSO can assist with selecting effective PPE. 

Lead is one of the best materials to block radiation because of its high density. It’s been successfully used for radiation shielding in healthcare facilities for decades. 

However, lead shielding isn’t the only option available. Alternatives to lead shields are growing in popularity, especially for wearable garments such as lead aprons. 

The main issue some clinicians have with lead aprons is that the weight can cause excessive fatigue during extended use. A study from the Korean Journal of Pain states that the average lead apron weighs 7 kg (approximately 15 lbs), which is a considerable amount of weight to have hanging from the shoulders throughout a long shift. 

A study from the Journal of Biomedical Physics & Engineering lists several lead-free alternatives that have a high density and are often lighter than lead, such as: 

• Tungsten

• Tin

• Antimony

• Bismuth

• Barium

Current research shows that the intensity of procedures matters when selecting materials. For example, a study from the European Journal of Radiology found that lead-free aprons performed about the same as traditional lead aprons at lower intensities below 90 kVp. However, as intensities increased above 90 kVp, traditional lead performed better. 

Therefore, while lead-free options have use cases to reduce fatigue, it’s important to consult with your RSO for the safety and shielding needs of individual procedures. 

The shielding used in medical facilities must be regularly maintained to ensure it remains clean, safe, and effective throughout its lifespan. 

We recommend performing annual inspections using X-ray scanning for PPE, such as lead aprons. A study from the Journal of Health Physics found that even small damage could progress rapidly, with small tears increasing by up to 270% in 10 months, so it’s important to identify defects early. 

Deep cleaning and disinfection are also essential since protective garments can become contaminated with harmful microorganisms during regular use. A study by Dr. Jaber of Wayne State found that 84% of lead aprons were contaminated with Tinea species (ringworm) and Staphylococcus aureus, which require deep cleaning to remove. 

We provide services that can help with these elements at Radiological Care Services (RCS). We offer deep cleaning and disinfection, inspections using radiographic scanning, garment repairs, garment disposal, and inventory management with our RADCOMPLY™ software. 

Contact us today to learn more about how we can help.