What Would You Do? Stop Shielding Your Patients?

Recently, a radiologic technologist working in a hospital in Aurora, CO reported the adoption of a new NO shielding policy for patients including NICU babies and pregnant women.  This has set off a firestorm of controversy via our community regarding the efficacy of patient shielding.

AHEC did a survey of our readership to find out the opinion or our readers and 86% responded they would continue to shield patients even if their facility changed the policy. Another 9% said they would selectively shield patients.  1% said they would quit their jobs if that was the facility policy.

The second question in the survey asked if patients should be protected from all sources of medical radiation if possible and not in the procedure field of view. Our readers voted 91% that they followed ALARA. Another 7% said they believe some radiation dose is so minimal that no harm occurs.

The third question was about personal practice for other when using a portable or C-arm.  Of the answers 37% reported they did not work with portables or C-arms, 11% said they provided lead protection for everyone, 20% had nurses and other healthcare staff move to 6 to 8 feet away from the x-ray tube and 31% said that they ask family members to step out of the room.

Many expert opinions have been declared as the gospel as to the safety of this new phase in radiation safety.  We asked our guru on radiation safety, Luis K Wagner, PhD, DABR, FAAPM, FACR to expound of the implementation of this policy and what he thought about the rigors of radiation safety.  He is one of the foremost authorities and is very practical in his clinical approach. He is working on a webinar on this subject that we hope will be available this quarter. In the meantime his series on radiation safety is online and you can find it in the AHEC store. We will be providing his answers in a series of articles, so stay tuned for more. His philosophy begins below.

Dr Wagner speaks:

  1. “Many live by the mantra ‘There is no safe dose’. That mantra has instilled fear of radiation in many. If it were true, then we should ban airplane travel and visits to Denver, Colorado because those activities increase our exposures to radiation.  In my opinion, that mantra is a lie. If by “safe” one means “zero risk”, then nearly everything we do during our visit with the mortal world is “unsafe” and there would be no use for the words safe and unsafe. There is no escape. We are all doomed. If by safe we mean that the activity does not MEASURABLY increase our risk for adverse effects, then lots of things become “safe”. People consider a trip to the grocery store or crossing the street safe activities as long as reasonable measures are taken to assure safety —e.g., wear a seat belt, wait for the light and look both ways. But we could still get killed because of some unanticipated event ( I have personally escaped from events that could have killed me. I once took a picture while on vacation and then left my position to join my wife. Five seconds later an 18-wheel runaway truck plowed into the spot where I had been standing). Some people consider very scary activities as safe — recreational sky-diving is one such activity. Suffice it to say, anyone who lives by the mantra that there is no safe dose will demand shielding in all circumstances as long as some truly minute level of radiation exposure can be saved. There is no useful discussion under these circumstances.”
  2. “Our own standard practices tend to instill an inordinate fear of radiation into workers. Every facility that uses fluoroscopy or radiography requires that protective aprons be worn by personnel who are in the procedure room while x rays are on. And by regulation wearing of lead aprons is required. This policy is a very good professional policy because it encourages best practices. This however has led to the perception that the radiation levels are dangerously high. That perception is false. If someone does happen to be in the room without a protective apron while x rays are on, it does not mean they are at any inordinate risk. Those levels are very low and a one-time exposure does not represent anything to fret over. What personnel sometimes fail to realize is that personnel wear lead aprons to prevent the long-term accumulation of radiation exposure to levels that do place them at inordinate risk.  In reality, if a medical radiation worker in Houston forgets to wear protective apparel for one day out of a year during fluoroscopy cases, they will not be at any greater risk from that additional one-day exposure than is an accountant who lives in Denver Colorado. This is because that accountant will be exposed in a year to more radiation from naturally existing radiation than the Houstonian because radiation levels in Denver are higher than they are in Houston. In fact, theoretically, the accountant would be at greater risk. I am NOT advocating personnel shed their protection. That would be professionally foolish and violates policies and rules. But the example sheds light on the reality of the low-level of risk involved. And this type of incident has occurred. I once had an angiographer call me with grave concerns about her health because she realized that she spent her entire busy day doing many procedures but she forgot to put on her protective apron. I assured her that while that was a pretty egregious violation of good practice, it did not place her at any measurable level of risk.”

Stay tuned for the next installment about radiation safety from Dr Wagner coming next.


6 thoughts on “What Would You Do? Stop Shielding Your Patients?

  1. I agree with Dr Wagner’s assessment. However, I predict that lawyers will be lining up to file suites against the hospital for disregarding the safety of their patients if there are problems. Lawyers could misrepresent the conclusions about radiation injuries to patients in our book “Minimizing Risks from Fluoroscopic X-Rays” and others to prove their points. I can imagine a scenario in a deposition (not unlike one case that I participated in) where administrator is asked “why did you so callously allow this unprotected patient and her fetus to be “injured” by (fill in the blanks) in your hospital. It has happened.
    Benjamin R. Archer PhD

    1. As scientists, and medical professionals, we should be guided by science rather than a fear of lawyers trying to use mis-information against us. The bottom line is that the risk to patients created by patient shielding (increased patient dose from any ABC/AEC/ADC system trying to “see through” a lead shield, obscured anatomy, etc.) FAR outweighs any theoretical benefit the shielding may provide to the patient.

  2. I preferred (retired now) to practice ALARA and excellent shielding protocols for all ionizing imaging studies. Most patients do not see or know radiation safety protocols (tight collimation, reduced fluoro time, correct exposure index, number of repeats, proper histogram, etc.), but they do know if you placed shields on them prior to an exposure. Shielding helps demonstrate to patients that we pay attention to ALL details of medical imaging and we care about their safety. I would continue the shielding even if hospital practices change.

    1. Interesting. You would continue a practice that you knew had the potential to increase radiation exposure to your patients instead of taking the time to educate them.

  3. I am the physicist who works at that Aurora, Colorado, hospital and have spearheaded the effort to NOT shield our patients. Please contact me if you have additional questions – I am happy to explain the reasoning and science behind my position.

    Rebecca M. Marsh, Ph.D., DABR

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