Thyroid Collars

A thyroid shield cover is personal protective equipment (PPE) worn around the neck to shield the thyroid gland from harmful scatter radiation. It’s commonly worn in radiology rooms or during interventional surgery with an apron or vest & skirt set.

The Korean Journal of Pain states that clinicians should wear thyroid shields during procedures involving C-arms or fluoroscopy when radiation exposure occurs, as the neck and thyroid gland may be exposed to radiation beams. 

Furthermore, a study published in the European Journal of Radiology highlights the benefits of wearing a thyroid shield, even during low-dose radiation procedures. The thyroid gland is highly sensitive to ionizing radiation, making adequate protection essential. This is particularly important for clinicians who frequently perform X-rays or interventional procedures, as repeated exposure increases the associated risks.

A thyroid shield protects the thyroid gland from harmful scatter radiation. Since the thyroid gland is located in the front of the neck, it usually comes as a collar that wraps around the neck to cover that area. 

Thyroid shields are typically used in conjunction with other PPE like lead aprons. The lead apron drapes from the shoulders down to just above the knees to protect critical organs like the breasts and gonads. Wraparound aprons may also cover the back. 

However, the missing piece is that many lead aprons still leave the neck and thyroid gland exposed to the radiation source. Therefore, the thyroid collar is often essential to protect that sensitive area. 

Many clinicians can have their thyroid gland exposed to scatter radiation during C-arm guided fluoroscopy. As the physician is leaning over the patient to operate, the patient's neck becomes greatly exposed and may even be in direct line with the radiation beam. 

A study from the European Journal of Medical Research states that when the radiograph is placed above the patient, the operating clinician’s thyroid becomes 4 to 5 times more exposed, meaning proper protection is vital. 

When you hear that lead shielding isn’t used anymore, it’s probably in dentistry. In February 2024, the American Dental Association (ADA) updated its X-ray shielding guidelines. The update stated that PPE like lead aprons or thyroid guards for dental X-rays are no longer necessary as long as dental offices use modern equipment that’s properly calibrated. 

However, lead shielding is still essential in many medical procedures where radiation doses are much higher. 

The FDA states that radiation doses during medical fluoroscopy are relatively high. Therefore, clinicians should wear PPE like lead aprons and thyroid shields to protect critical organs from exposure. 

The Association of periOperative Registered Nurses (AORN) also found that the average C-arm emits a radiation dose of 2 rem per minute, meaning following ALARA (as low as reasonably achievable) principles is essential. ALARA involves 3 key principles: time, distance, and shielding. Based on that, the AORN recommends:

• Time: Track beam exposure time and prepare for procedures to operate as efficiently as possible. 

• Distance: Remain at least 6 feet away from the radiation source or stand outside the direct radiation beam when possible. 

• Shielding: Wearing lead aprons, disposable thyroid shield, gloves, and eyewear to protect crucial organs when using C-arms.

The American Thyroid Association (ATA) says that using thyroid shields is safe, and it’s recommended to use a thyroid shield for radiation protection during high-dose procedures due to potential risks of thyroid cancer or damage to thyroid function from ongoing exposure. 

However, the statement from the ATA did mention that the thyroid shield isn’t necessary for every imaging procedure. For example, wearing a thyroid shield for mammograms isn’t recommended by the ATA since the potential radiation dose is low. Nevertheless, even if thyroid shields aren’t necessary for every procedure, they are still safe and effective when used.

A study in 2018 stated that a 0.5 mm thyroid shield could reduce the radiation dose received by 2.5 times. Therefore, it’s a highly effective and necessary shielding method when using equipment that emits high doses of radiation. 

Another study in 2013 showed even better results. Researchers found that wearing a traditional lead thyroid shield snugly around the neck reduced the radiation dose from C-arm fluoroscopy by approximately 8.5 times. The study emphasized that the best thyroid shield is one that fits snugly. Wearing one that was too loose showed a noticeable increase in radiation dose. 

To add even more evidence that thyroid shields are effective, their use has risen substantially in recent years. A study in the American Journal of Roentgenology stated that the use of thyroid shields in radiology departments increased from 47% to 94% between 1996 and 2016. 

It’s clear that medical facilities are recognizing the need for PPE like thyroid guards and making an effort to use them to keep clinicians and patients safe during high-dose procedures. 

The typical thyroid shield for radiation protection will contain a protective core that acts as a barrier against radiation beams. 

Lead is a commonly used material for radiation protection because of its high density. When X-rays or gamma rays come into contact with lead, it significantly slows their energy and can absorb them before they reach the body.  

While lead is still the most common for PPE, some alternative materials are growing in use. Alternative materials that may be used for thyroid guards include:

• Tin

• Tungsten

• Antimony

• Copper

• Barium

• Bismuth

• Yttrium

Studies examining the use of alternative materials in thyroid shields are still limited. However, one in 2013 did show that lead-free thyroid guards performed similarly to traditional lead. 

Additionally, research comparing lead and lead-free aprons has shown similar results. For instance, a study by the European Journal of Radiology found that lead and lead-free aprons performed similarly in low-dose procedures. However, at higher voltages above 90 kVp, traditional lead performed slightly better.

Maternity lead aprons are a good idea to protect the mother and fetus. Depending on the procedure, a slightly thicker apron (up to 1.0 mm) may be recommended to provide additional protection. You should consult your medical facility’s radiation safety officer to ensure the appropriate lead equivalence is selected. 

OSHA’s guidelines also mention that managing radiation exposure is especially crucial for pregnant healthcare workers. OSHA recommends that pregnant workers shouldn’t be exposed to more than 500 mrem (5 mSv) of radiation during the pregnancy term to avoid health risks. 

Limiting exposure time and wearing the appropriate shielding like lead aprons, thyroid shields, gloves, and eyewear will help maintain safety.

Cleaning lead garments, such as aprons and thyroid shields, involves a detailed process to ensure that no harmful microorganisms or bacteria remain on the material. The typical process we use to perform deep cleaning and disinfection at Radiological Care Services (RCS) is as follows:

1. Pre-service evaluation: Inspect the garment for areas that need special attention. 

2. Cleaning and disinfection: We apply an EPA-registered cleaning product using friction to perform deep cleaning. The CDC recommends using friction to effectively remove dirt, microorganisms, and bioburden from the material. Afterward, a garment-safe sanitizing agent is applied to remove any remaining microorganisms. 

3. Post-service evaluation: We conduct an additional ATP test to ensure all contaminants are removed from the garment. Once the process is complete, we record it in our RADCOMPLY™ inventory software so you know when your garments were last cleaned and are prepared for an audit. 

Government bodies, such as AORN, recommend quarterly deep cleaning of high-touch objects to prevent the buildup of harmful contaminants. 

Between quarterly cleanings, you can also use some daily cleaning products to remove dirt and germs after use. We recommend Ecolab Quaternary Based Wipes or Clorox Hydrogen Peroxide Wipes, which use a disposable microfiber cloth that applies friction without harming the garments. However, remember that daily wipe-downs help, but they don’t replace deep cleaning, which is built to remove harmful microorganisms.

Maintaining thyroid shields requires proper storage and regular inspections. 

The ideal way to store thyroid shields is hanging them from a secure storage rack. Many lead apron storage racks come with extra pegs to hang accessories like your thyroid collars. 

When hanging them, make sure the materials remain straight and don’t bunch up. Folds in lead protective equipment can cause cracks, holes, or tears. One study from Radiography Open showed that this type of damage could reduce a lead garment’s shielding capabilities.  

In cases where thyroid guards can’t be hung, such as during transport, it’s best to lay them flat to avoid folding or bunching the material. 

Additionally, research published in the Korean Journal of Pain recommends annual inspections for thyroid shields, just like you should annually inspect other PPE like lead aprons. 

The best inspection option is X-ray scanning the garments. A radiographic scan can identify small damage that isn’t visible to the eye. Even small pinholes must be repaired promptly to avoid worsening damage. 

One study on lead aprons in the Journal of Health Physics found that even minor damage can progress rapidly, with tears increasing by up to 270% in 10 months. The results can be similar with other garments as well, such as thyroid shields. 

The price of thyroid shields can vary depending on their material, thickness, features, and the manufacturer selling it. Most thyroid shields from Burlington Medical range from $100 to $280. Most thyroid guards from Techno-Aide range from $94 to $121. 

The primary factor that impacts prices is the material used:

• Traditional lead is the least expensive

• Lightweight lead is a little more expensive

• Lead-free is the most expensive

The thickness can also impact the price. Thicker thyroid collars may be more expensive but provide more protection in high-dose radiation procedures. 

Lastly, other features and accessories could impact the price, such as the fabric type, closure style, or an optional apron attachment. 

The process required to deep clean, inspect, and repair lead garments is often costly and time-consuming for medical facilities to perform in-house. 

You can partner with us at Radiological Care Services (RCS) to ensure your thyroid shields, lead aprons, and other garments remain clean and effective throughout their lifespan. We make the entire process easy to manage so you can focus on what you do best, providing exceptional patient experiences. 

Services we offer include:

• Deep cleaning and disinfection

• Annual inspections using X-ray scanning

• Garment repairs

• Garment disposal

• Inventory management with our RADCOMPLY™ software

Ready to optimize protective garment cleaning and maintenance? Contact us today to learn more about how we can help.