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Protective Apron Inspection
Posted on Tuesday, June 11th, 2013, under Radiation Safety
By Greg Sackett, M.S., CHP
The inspection of radiation protective aprons is a mysterious requirement without much guidance. Many hospitals and clinics have heard something about inspecting aprons, but many have questions as to what they need to do.
The primary requirement for protective apron inspection is given by the Joint Commission. Some States also require inspection of protective aprons but Missouri, Kansas and Iowa do not have any such requirements. This means that technically only those institutions accredited by the Joint Commission are required to inspect their protective aprons annually.
The Joint Commission requirement may be satisfied by physical inspection OR fluoroscopic examination of protective aprons annually. While fluoroscopic examination is believed to be more thorough, it may not be necessary for newer aprons and may deliver unnecessary exposure to the persons testing the aprons. Fluoroscopic testing may be considered for aprons considered suspect following physical examination. If fluoroscopic testing is performed, low technique factors and not automatic exposure control should be used to reduce operator exposure.
The keys to a successful apron inspection program are as follows:
- Uniquely identify each item of protective equipment with a number and some method of determining when it was last inspected. This may be done on the label/tag itself or with a database that tracks all of the items and when they were inspected. If a database is used, results must be available for inspection by the Joint Commission.
- Develop a procedure for inspecting the protective equipment, either physically or fluoroscopically (or both).
- Develop criteria for determining when protective equipment is defective. Such criteria may include:
- Tears, perforations, or seam separation.
- Holes larger than 15 mm2 unless it is not positioned over a critical organ.
- Velcro that is no longer functioning.
- Aprons determined to be defective should be removed from service immediately and disposed of properly (as hazardous material/waste if they contain actual lead).
Establishment of a protective apron inspection program may not be required at your facility but should be considered in order to give assurance to staff that the protective equipment they have available is not defective.
- “Inspection of lead aprons: Criteria for rejection,” Operational Radiation Safety Volume 80, May 2001
- “Implementation of an X-ray Radiation Protective Equipment – Inspection Program” published in Operational Radiation Safety Vol 82, Feb. 2002, pp 551-553
Radiographic Technique Still Matters For Image Quality and Patient Dose
Posted on Saturday, March 23rd, 2013, under Radiography
Shirley Bartley, M.B.A., RT (R)(N)
The new technologist at the hospital radiology department went to do a portable in the ICU. The patient looked average size. She looked for the technique chart to set the correct exposure factors. There was no chart to be found. She guessed at the technique based on what she could remember from the last place she worked. When the new tech returned to the department the supervisor was reviewing the image. “You are going to have to repeat this portable chest. There is an image quality problem. You didn’t penetrate the mediastinum.” The supervisor told the new tech.
If the kVp is too low the anatomy will not be properly penetrated. The fine detail in dense areas of the body will just not be there. This will jeopardize the radiologist ability to make a correct interpretation of the patient’s condition.
A few minutes later the new tech was working in room 2 with a seasoned employee. The new tech selected the radiographic technique from the anatomic programing feature on the operator’s consol. “Don’t use that. It doesn’t work. I have my own technique.” The new technologist made a mental note to try to remember the technique.
Without standard technique systems that are used by everyone image quality will be inconsistent. It is difficult for the radiologist to see changes in the patient’s condition when totally different radiographic technique is used. Technologist that just “remember” their own techniques are frequently wrong.
After lunch the new tech was working with a radiology student. They did an abdomen using automatic exposure control (AEC). Viewing the image, the new tech pointed out that the exposure indicator value was well above the acceptable range. The students said, “They don’t pay any attention to the number here.”
With digital systems the image that is over exposed no longer comes out black. The only way we can determine that the patient was over exposed is with the exposure indicator value. The AEC unit that is not properly calibrated will not produce the correct quantity of radiation for the image. When the exposure indicator value is ignored the patients may be overexposed unnecessarily.
These three situations describe common problems for image quality and patient dose. ISS, Inc. can assist you in maximizing image quality while keeping patient dose as low as reasonably achievable (ALARA). For more information access our recent white paper.