In a procedure involving ionising radiation, if the staff are not wearing lead aprons, thyroid shields, and lead glasses, what is the appropriate action?

Immediate Action Required: Stop the Procedure

The procedure must be stopped immediately, and all personnel must don complete protective equipment—including 0.25-0.5 mm lead-equivalent aprons, thyroid shields, and leaded eye protection with side shields—before any further radiation exposure occurs. 1, 2

Why Immediate Cessation is Non-Negotiable

The American College of Cardiology explicitly states that when circulating personnel need to approach close to the patient, the physician operator has a responsibility to not operate the x-ray system until proper protection is in place. 1 This principle extends to all personnel in the radiation field—continuing without protection violates fundamental radiation safety standards. 2

Critical Protection Requirements

All medical personnel working in an x-ray procedure room must wear the following protective equipment before any radiation exposure: 1, 2

• Lead aprons (0.25-0.5 mm lead-equivalent): These absorb 95% of 70 kVp x-ray and 85% of 100 kVp scatter radiation, providing substantial protection that is non-negotiable. 1, 2

• Thyroid shields: The thyroid collar alone decreases the effective dose to the operator by approximately 50% by protecting the thyroid and cervical bone marrow—two highly radiosensitive structures in areas of high scatter. 1, 2

• Leaded eye protection with side shields: Required for personnel working close to the x-ray source, as proper use combined with ceiling-mounted shields reduces operator eye exposure by a factor of 19. 1, 2

The Correct Response Algorithm

1. Immediately halt all radiation exposure: The radiographer must stop the procedure the moment unprotected personnel are identified in the radiation field. 2

2. Ensure all personnel don complete protective gear: Every person in the x-ray procedure room—not just those within 1 meter—must wear lead aprons, thyroid shields, and appropriate eye protection before resuming. 1, 2

3. Verify proper equipment placement: Confirm wraparound aprons extend to the knees, thyroid collars are properly positioned, and eye protection includes side shields. 3, 2

4. Resume only after complete protection: The procedure may continue only when all personnel are fully protected and positioned appropriately. 2

Common Pitfalls to Avoid

Do not allow only the primary operator to leave and don protection while others remain unprotected. This violates the fundamental principle that all personnel in the x-ray procedure room require shielding, regardless of their proximity to the radiation source. 2 While the inverse square law means those farther from the source receive less exposure, scatter radiation affects everyone in the room. 1

Do not assume circulating personnel are safe without protection. Even personnel positioned remotely from the x-ray source should wear protective aprons if they remain in the room, though they may receive negligible exposure if positioned >8 feet away. 1, 2

Do not proceed with incomplete protection. Omitting any component—particularly the thyroid shield—substantially increases radiation risk, as the thyroid collar alone reduces effective dose by half. 1, 2

Additional Safety Considerations

The ALARA principle (As Low As Reasonably Achievable) mandates minimizing radiation exposure through proper equipment use, maintaining distance from x-ray sources, and using shielding. 1 Ancillary personnel not essential to the procedure should not be assumed to be knowledgeable in radiation protection and require explicit instruction before entering the radiation field. 2

Personnel shielding should be augmented with ceiling-mounted lead-impregnated shields, under-table mounted shielding, and proper positioning to maximize the inverse square law protection. 1