Intended for healthcare professionals

Rapid response to:


Doctors' knowledge of radiation exposure: questionnaire study

BMJ 2003; 327 doi: (Published 14 August 2003) Cite this as: BMJ 2003;327:371

Rapid Response:

Lead Aprons: Historical & Scientific Basis for Change*

The U.S. Radiologic Technologist Health Study 1983-1998, which
included 90,305 radiographers (of whom 77% were female), revealed
increased incidence of breast cancer among female radiographers.
Interestingly, standard lead aprons, which have not changed appreciably in
almost a century, offer no protection to the lateral aspect of the breast
or axillary region, particularly in large-breasted persons. The leaded
rubber does not drape well over breast, the arm holes or arm openings on
the apron thus being projected foreward, thereby increasing exposure of
this radiosensitive area. I contend that to some degree, perhaps more
founded in historical retrospect than in mathematics, the "apron" design
itself contributes fundamentally to breast cancer incidence among female
radiographers. Of the three cardinal principles of radiation safety
(time, distance, and shielding), perhaps shielding is the most amenable to
affect safety outcomes.

In the US, it took 50 years to outlaw x-ray hair removal machines.
The practice ended in 1946. Shoe-sizing x-ray machines were pulled from
stores in the early 1950's after 40 years of use. With lead protective
aprons its been about 80 years now. Considering the increased incidence
of breast cancer in female radiographers, perhaps its time for a little
innovation in lead "aprons" relative to the upper female anatomy.

The self-descriptive term "apron" equates to the open-sleeve, or
sleeveless pattern, characteristic of garments intended to protect the
torso. While materials, fasteners, velcro, and colorful print styles have
evolved, the basic lead apron design has remained frozen in time for the
better part of a century! During the early 1900's with the determinations
by Bergonie & Tribondeau (1906), and Ancel & Vitemberger (1925),
the biological aspects of radiation-induced injuries were apparent.
Cancerous limbs, amputations and other horror stories prompted best-
practice modifications increasing the use (or at least the availability)
of protective aprons by the year 1925. Progressive technical improvements
in x-ray tubes (now shielded!), collimation cones, and techniques in
general, resulted in a generalised 'relaxation' of safety concerns
regarding medical x-rays which persists to this day. Once dangerous
machines are now safe, how can they be dangerous? Today, like
children fighting on a shoolyard, great academics and great scientists
argue between radiogenic cancer and hormesis. If you could ask Madame
Curie or Clarence Dally or Elizabeth Fleischmann today, had they known the
"potential" risks, would they have used the best available protection,
what do you think their reply would be? Regarding human life, espically
one's own, rational individuals usually err on the side of caution.

Competing interests:
None declared

Competing interests: No competing interests

14 February 2004
J. B. White
Radiologic Technologist
CHD Hospital-Radiology Dept, TX - USA