No need to wear a lead apron during an x-ray examination

2024-02-09 13:38:02

We wear it when we have an x-ray at the dentist or hospital. The lead apron is supposed to protect the reproductive organs and the fetus from X-rays. But its benefits are negligible, or even zero, according to scientists. Eight Quebec professional orders — including those of medical imaging technologists, dentists and doctors — are therefore asking Quebec to modify the legislation in order to remove the obligation to put it on the patient.

“There is a scientific consensus. The lead apron is useless,” says Vincent Dubé, president of the Order of Technologists in Medical Imaging, Radiation Oncology and Medical Electrophysiology of Quebec (OTIMROEPMQ).

The use of the lead apron has been recommended for around fifty years for patients undergoing x-rays, with the aim of protecting the gonads (ovaries and testicles) and the fetus. Initially, there was concern that X-ray radiation would impact reproductive cells and cause genetic mutations. Radiation doses were much higher then than today.

Since then, wearing it has become an almost sacred ritual during x-rays at the dentist or hospital. But research has not demonstrated the necessity, indicates Richard Tremblay, vice-president of medical physics at the Association of Biomedical Physicists and Engineers of Quebec and consultant for the Order of Dentists of Quebec in this matter. “Despite the doses that we had 50 years ago, there have been epidemiological studies that have been carried out and, with the use of the lead apron, we have never observed any protective effect on the fetus or the gonads,” he explains.

The American Association of Physicists in Medicine recommended in 2019 the abandonment of the lead apron. Several organizations and several groups then followed suit, including the Food and Drug Administration (FDA), in 2023. Last week, the American Dental Association also decreed that the lead apron was no longer necessary.

In Canada, the federal government has no longer recommended its compulsory use during routine dental x-ray examinations since 2022. However, Quebec law still requires it for patients, both at the dentist and in the hospital.

The OTIMROEPMQ and seven professional orders (doctors, nurses, chiropractors, podiatrists, dental hygienists, dentists and engineers) have therefore recently taken steps with Quebec to modify the regulations implementing the Act respecting medical laboratories and conservation of organs and tissues. They registered with the Quebec Registry of Lobbyists. “The law is not new and there is a gap with scientific evidence,” says Véronic Deschênes, director of continuing education at the Order of Dentists of Quebec.

Ultimately, wouldn’t it be simpler to keep it? “It seems like a non-issue, because we say to ourselves: ‘If the apron is useless, we can leave it and it doesn’t matter,’” recognizes Vincent Dubé. But resorting to it is not without consequences, according to him. “We have a good percentage of examination repeats which are due to the position of the lead apron in the field of exposure, particularly in pediatrics,” he argues.

However, when a patient has an X-ray again, they are exposed to additional radiation. “The doses are very minimal at the moment. What pushes us to action is not because we have identified a danger and that we are in doses that are too high for the population. But the issue of the relevance of radiological examinations is still relevant,” he emphasizes.

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False sense of security

The leaded apron also creates a “false sense of security”, which has “impacts on the relevance” of diagnostic examinations, believes Vincent Dubé. “Sometimes, it is trivialized to request radiological examinations, because we say that in any case, in a pregnant woman, for example, there will be a lead apron which covers the fetus, so it is protected. Which is not the case at all. »

The president of the OTIMROEPMQ wishes to reassure pregnant women: the radiation to which the fetus is exposed is “negligible” during a lung x-ray, for example. “The direct beam is not on the fetus,” he explains. The dose that the fetus receives is through the radiation diffused inside the body, and there is no way to avoid that. It’s a bit like X-ray ricochets. That’s exactly why the apron is useless, because it’s happening inside. »

Even if the doses received by the fetus are negligible or minimal (except in the case of a CT scan, where they are considered “moderate”), it is always better to avoid unnecessary radiological examinations, he specifies. Question of reducing the accumulation of doses “as much as possible”.

For Vincent Dubé, it is also a question of “scientific honesty” towards the population. Citizens have the right to know that they are not protected as “they think” with the lead apron. They may ask about “exam frequency.” “We increasingly want patient partners who are involved in their care and their services,” he recalls. It’s the same thing in medical imaging. We want the patient to be able to have this reflection and to be able to say. “Is this really relevant?” “.

If Quebec removes the compulsory wearing of a lead apron from the law, the professional orders will carry out information campaigns to notify the public of the change. Those who still want to keep it will be able to do so, assures Mr. Dubé.

The professionals who perform the x-rays will continue to wear it when necessary. Just like the parent who accompanies a child during the exam. “The person who undergoes the X-ray has his dose of radiation, but has a benefit in the end. The accompanist has no benefit. We can spare him the dose,” explains Vincent Dubé.

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