No more lead apron during an X-ray

Shields not needed, can increase radiation

NEW HAVEN — Even the doctors see it as “monumental shift.”

Those heavy lead aprons we’ve always worn during an X-ray are being phased out at some hospitals in the state and experts say it’s for health reasons.

The lead aprons are no longer are being used at Yale New Haven Hospital, a change in longstanding practice accelerated by the COVID-19 pandemic.

Bridgeport Hospital also is ending their use, and the other Yale New Haven Health hospitals, including Greenwich Hospital, will end the practice.

“We are one of the first, if not the first in Connecticut, and there’s only a handful of hospitals nationwide” to discontinue use of the lead shields, said David Facchini, diagnostic imaging manager at Yale New Haven Hospital. “We are a pretty big innovator in terms of this practice change.”

Radiologists and doctors have long talked about whether the shields, used primarily to block radiation from the ovaries and testes, really do any good, especially given the low amounts of radiation used in modern X-rays.

There is evidence that they actually can increase the amount of radiation a person receives, especially if they block a portion of the scan and it needs to be done a second time.

“This is a monumental shift in what has been standard practice in radiology for 50-plus years,” said Dr. Jay Pahade, radiology medical director for quality and safety at Yale New Haven Health. “They were taught over and over again to shield, to shield, to shield … to protect the patient.”

However, research has found that the lead shielding not only does little if anything to protect the gonads from radiation that might cause genetic defects or cancer, but that it may result in an increase, said Adel Mustafa, chief of diagnostic radiology physics, radiology and biomedical imaging at the Yale School of Medicine.

Medical professionals in the past had “the mistaken idea that they are going to protect the gonads from scattered radiation,” he said. “If one is to look at the amount of external radiation, it is insignificant compared to the internal scatter.”

Another issue is that modern X-ray machines use an “auto-exposure control device” to measure how much radiation to emit. If the lead shield is detected by the machinery, “it will actually be seen … as if it is a large person” and increase the amount of radiation, Mustafa said.

Facchini said, “It actually increases the dose and that has been going on for a long time.”

When preparing an X-ray, radiologists follow a standard called ALARA: as low as reasonably achievable, Pahade said.

“That is kind of our gospel in radiology when it comes to exposure to the patient,” he said. Radiologists use “the least exposure possible to answer the diagnostic question,” such as where there may be a pelvic fracture.

“We want to use enough radiation to get a good-quality image … We want to use the least amount possible,” he said.