how well do lead aprons protect you?

[marie337]

I just started a neurosurgery elective and I'm 10 weeks pregnant. I'm not looking for medical advice, just trying to track down some figures on how well lead aprons protect you with fluoroscopy. I try to stand as far away as possible, and I hope to get one of those badges tomorrow so I can see what amount is getting through. I'm just concerned because I've read 95-98% protection, but that report was about 5 years old. Does anyone have any newer numbers on this?

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[jake2]

Regardless of the numbers, if I were you, I'd just explain the situation to your resident/attending. I'd have a hard time believing they'd be that passionate about you seeing an angio or NIR case that they'd think any less of you. (I actually did a couple of neurosurg rotations and never stepped foot in fluoro).

As a practical matter, you would probably be exposed to extremely little radiation, but something visceral about a pregnant woman being in a fluoro suite would jump start my neurotic instincts.

 

[flux=rad]

Lead hasn't changed much. Even lightweight aprons attenuate ~90% of incident radiation with standard xray imaging. The slightly heavier aprons up to 95-99%. Standing a good distance away, especially during actual exposures as opposed to fluoroscopy, is also helpful. Scatter dose at ~1 meter from the patient is approximately 0.1%. Pregnant techs normally wear one badge on the collar and another at the waist, underneath the lead. I would think that the biggest question for you would be what you're actually doing on the rotation. There's a big difference between a couple of c-arm spot views during a fusion and spending all day in the angio suite watching neuro endovascular interventions.

 

[colbgw02]

A standard lead apron is supposed to attenuate somewhere around 98% of the x-ray photons sent its way.

 

[marie337]

There's a big difference between a couple of c-arm spot views during a fusion and spending all day in the angio suite watching neuro endovascular interventions.

They are just doing random shots. If they use it for localization before we scrub, then I step out of the room. But, if it's mid-case I try to stand as far away as possible. Yesterday was my first day in the OR with them and every case used it at least once, but only for a few shots. I'm just worried about doing it for 4 weeks straight. I'll go chat with the radiology dept this morning about getting a badge to wear under the lead and see what their recommendations are.

 

[hans19]

They are just doing random shots. If they use it for localization before we scrub, then I step out of the room. But, if it's mid-case I try to stand as far away as possible. Yesterday was my first day in the OR with them and every case used it at least once, but only for a few shots. I'm just worried about doing it for 4 weeks straight. I'll go chat with the radiology dept this morning about getting a badge to wear under the lead and see what their recommendations are.

Tell them you are pregnant. Its your responisibility. After that it becomes theres. In radiology, even though you can stay within limits for radiation exposure using appropriate measures, there is no 'SAFE' amount of radiation. Radiology residents who were pregnant were placed on fluoro free rotations for the duration of their pregnancy. The fetus is most radio-sensitive between 5-8 weeks (organogenesis).

For the love of God, tell them you are pregnant!

 

[OHMAN0125]

Tell them you are pregnant. Its your responisibility. After that it becomes theres. In radiology, even though you can stay within limits for radiatin exposure using appropriate measures, there is no 'SAFE' amount of radiation. Radiology residents who where pregnant were placed on fluoro free rotations for the duration of their pregnancy. The fetus is most radio-sensitive between 5-8 weeks (organogenesis).

For the love of God, tell them you are pregnant!

I agree as well. Dont play macho to the surgeons or anything about this. If they think any less of you then they are being ridiculous. If anything happens are u going to be able to live it down? You'll always wonder what if....

 

[marie337]

I agree as well. Dont play macho to the surgeons or anything about this. If they think any less of you then they are being ridiculous. If anything happens are u going to be able to live it down? You'll always wonder what if....

I've made sure that everyone knows. The surgeon has been wonderful about it. Today I went down to radiology and asked for a badge. They said they would have to order one for me that can be swiped daily. They also arranged for me to have a two piece gown which weighed about 20lbs, but better safe than sorry. I even managed to get a lead door in the OR so I could be double protected. One procedure involved standing next to the c-arm for about half of the procedure. So, I gave up my spot in the front row and stood in the corner for a while. I think it will be okay. I see my ob on Friday, so I'll make sure that 3 more weeks of this will be okay.

 

[OHMAN0125]

I've made sure that everyone knows. The surgeon has been wonderful about it. Today I went down to radiology and asked for a badge. They said they would have to order one for me that can be swiped daily. They also arranged for me to have a two piece gown which weighed about 20lbs, but better safe than sorry. I even managed to get a lead door in the OR so I could be double protected. One procedure involved standing next to the c-arm for about half of the procedure. So, I gave up my spot in the front row and stood in the corner for a while. I think it will be okay. I see my ob on Friday, so I'll make sure that 3 more weeks of this will be okay.

I really doubt that ur OB will tell u it's definitely okay. No one will for that matter. Basically since u seem to be ok with it, you just have to be prepared for any consequences in the future if they arise.

Personally if I were the surgeon i'd tell u to leave no questions asked. I dont want anything on my conscience.

 

[marie337]

I really doubt that ur OB will tell u it's definitely okay. No one will for that matter. Basically since u seem to be ok with it, you just have to be prepared for any consequences in the future if they arise.

Personally if I were the surgeon i'd tell u to leave no questions asked. I dont want anything on my conscience.

Yeah, this really sucks. I don't want to just hang out in the clinic all day. But, today we only had 1 case that didn't require the c-arm. Everything that I read says that I should be okay, but there's always that 1-4% chance. I don't have any more cases before my appt, so I'll talk to my OB on Friday.

 

[Amxcvbcv]

Yeah, this really sucks. I don't want to just hang out in the clinic all day. But, today we only had 1 case that didn't require the c-arm. Everything that I read says that I should be okay, but there's always that 1-4% chance. I don't have any more cases before my appt, so I'll talk to my OB on Friday.

If you're doing IR procedures in a suite with a control room, I'd just watch from there. As medical students, the benefit on return for being in the room is pretty low unless you've got a specific agenda.

 

[bobafart]

5mm of lead give you 95% protection of the 1% of scatter you receive 1m from the x-ray source

so, basically, you arent getting very much radiation

 

[marie337]

5mm of lead give you 95% protection of the 1% of scatter you receive 1m from the x-ray source

so, basically, you arent getting very much radiation

Those are the numbers I've read too. I try to stand at least 15 feet away from the source too. My ob today said she felt comfortable with me being in there, but she will do some research today for me too.

 

[f_w]

Talk to the institutional radiation safety officer and declare your pregnancy. He/she will likely set you up with one of his/her designees to go through the basics of radiation protection. Some pregnant 'radiation workers' elect to wear double (1mm equivalent) lead aprons during early pregnancy. Imho the additional risk by lugging around such a heavy piece of equipment is likely to outweigh the incremental radiation protection benefit.

Time
Distance
Shielding

Time is linear (1/2 time = 1/2 dose)
Distance is square root (1ft instead of 6in = 1/4 dose)
Shielding is constant (95% for typical lead apron and typical x-ray energies)

Standing back 3-4 ft is going to reduce your dose tremendously, way more than wearing a second apron (having a fat scrub-nurse between yourself and where the beam passes the patient will pretty much eliminate your exposure). Key is to avoid the position right next to the c-arm.