Purpose: To provide a procedure for the Use of, Purchase, Annual survey, Maintenance, Documentation, Storage, and Disposal of leaded garments.
Scope: Staff that use department issued or privately purchased lead garments
Key Points:
- The use of lead protective devices and garments maintains the ALARA program principle designed for occupational exposures that are ‘As Low As Reasonably Achievable’.
- In this document “lead” is used to indicate either “lead” or “lead equivalent” materials.
Policy Statement(s):
All personnel present in the room where the ionizing radiation is being used are required to wear protective lead garments.
Procedure:
- Due to requirements in place by the Connecticut Department of Energy and Environmental Protection (DEEP) and the standard in place by The Joint Commission, health care organizations are required to perform annual inspections of medical equipment, including lead protective garments (aprons and thyroid shields etc…). Lead garments significantly reduce the occupational exposure received during diagnostic imaging procedures.
- Each imaging area is responsible for:
- Lead apron purchases (from an approved lead apron apparel vendor only)
- Inspection upon arrival
- Maintaining an inventory (database) of all leaded apparel in the department
- Performing an annual survey of lead apron inventory
- Appropriate storage of lead apparel
- Cleaning of the lead apparel
- Disposal of lead garments inventory (as needed)
| Purchasing | Department Responsible |
|---|---|
| Lead or lead equivalent protective garments can be color-coded to differentiate facility departments. Department name may be embroidered on the garment. If ordering for specific personnel, Velcro name tag can be used. | All personnel |
| Protective garments will include, at a minimum, apron coverage from shoulder to mid-femur with an anterior lead or lead equivalent thickness of at least 0.25 millimeters (0.25 mm) for General X-Ray procedures (non-intervention fluoroscopy procedures). For Fluoroscopy / Interventional procedure areas, lead or lead equivalent thickness of at least 0.35mm is recommended. Thyroid shields of 0.5 mm lead/lead equivalent thickness are recommended. Lead glass screens and/or personal lead glasses with side shields of at least 0.75 mm lead or lead equivalent will reduce the exposure to the lens of the eyes. Personnel working at bedside in high exposure fluoroscopy procedures are recommended to use lead eye protection. Certain staff may be required to wear lead glasses based on dosimetry review. | All personnel working with Radiologic producing equipment |
| Before purchasing lead garments, department leadership approval and a PO# is required | The Department Lead- Garment Survey Coordinator |
| New or Refurbished Apron Arrival-Receipt of New Lead Apron Inventory | Department Responsible |
|---|---|
| New leaded apparel is added into the Electronic Database System. Each item has a unique identifier. | All Lead Garment Using Departments |
| New leaded apparel is surveyed for visible damage (wear and tear) and sagging and deformities. New Leaded apparel is imaged (using fluoroscopy) before use Imaging technique: -Use manual settings and low technique factors (e.g. 80 kVp). Do not use the automatic brightness control; this will force the tube current and high voltage to increase, yielding unnecessary radiation exposure to personnel and wear on the tube. -Lead apparel is to be rejected/discarded if the fluoroscopy inspection determines: -A defect greater than 0.4 inches2 found on parts of the apron shielding a critical organ. (e.g., chest, pelvic area). -A defect greater than 2.5 inches along the seam, in overlapped areas, or on the back of the lead apron. -Thyroid shields with defects greater than 0.3 inches2 | All Lead Garment Using Departments |
| All inspected lead garments will be identified in a manner that the wearer knows which year it was last inspected. | Lead Apron Coordinator Inspector of Lead Apparel |
| Annual Inspection of Lead Apparel Inventory | Department Responsible |
|---|---|
| A visual and tactile inspection is required each year for every lead or lead equivalent garment in inventory. Look for visible damage (wear and tear) and feel for deformities (evaluate the edging/stitching of each apron for consistency). In cases of questionable condition, use fluoroscopy (see imaging technique above) to evaluate for holes and cracks. For departments that do not use fluoroscopy contact the Radiology department for assistance with Fluoroscopy. Confirm each lead or lead equivalent item in the department inventory has been evaluated and approved annually for continued use in the department. Document annual evaluation results in the electronic Database System. | All Lead Garment Using Departments |
| Storage of Lead Apparel | Department Responsible |
|---|---|
| Radiation protective aprons/vests are to be hung by the shoulders or laid flat. Gloves and thyroid shields should be laid flat when not in use. Lead apparel must NOT be folded or creased during storage. | All Lead Garment Using Departments |
| Cleaning Of Lead Apparel | Department Responsible |
|---|---|
| Spot clean and dry with a cloth. If needed a soft bristle scrub is effective. Sanitize per department policy. Do not soak or submerge in water. Avoid harsh cleaning agents (bleach) to maintain apron cloth integrity. | All Lead Garment Using Departments |
| Electronic Database System Inspections | Department Responsible |
|---|---|
| Maintain a concise log of all leaded garments (per department). | Electronic Database System |
| Before the inspection due date, inspect and log each garment in the department’s electronic database. New aprons arriving after inspection due date, will be surveyed upon arrival and will be surveyed again with annual department apron inventory during the inspection due date. | The Department Lead- Garment Survey Coordinator |
| If a lead garment is not found during the annual survey, it must be documented as missing in Electronic Database System. If that the lead garment is not located within 6 Months of the inspection due date it is to be removed from Electronic Database System active inventory and placed into the archived inventory. If the garment is found at a later date, it can be surveyed and brought from the Electronic Database System archive inventory and back into Electronic Database System active inventory. | The Department Lead- Garment Survey Coordinator |
| Disposal | Department Responsible |
|---|---|
| Each department is responsible for the appropriate disposal of lead apparel. | The Department Lead- Garment Survey Coordinator |
| If inventory tags are used to identify lead garments, contact your supervisor or Radiology to ensure the removal of inventory tags is completed before disposal. | The Department Lead- Garment Survey Coordinator |
| Apron Vendor companies may exchange apparel (old for new) when purchasing new leaded items. If the vendor company cannot accept an exchange of old apparel, contact the Industrial Hygiene department for guidance on disposal of lead apparel. | The Department Lead- Garment Survey Coordinator |
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