Answer to Question #6118 Submitted to "Ask the Experts"

I am a pregnant general surgeon who does some fluoroscopic procedures and I also do lymph-node mapping using ^99mTc and other radioactive isotopes. Is wearing lead aprons adequate protection for the fetus and is the abdominal apron adequate considering some of my procedures take many, many hours to complete (back strain)? I will not have a daily exposure, unlike some of your other questioners who work in radiology, so I am assuming the lead is adequate.

Thank you for your question. The short answer to your question is, yes, the lead apron is adequate to protect you and the fetus from the radiation exposure although we don't usually promote the use of a lead apron for work with most radionuclides. There is a minimal amount of exposure that would be received from the ^99mTc used for the sentinel node cases. There is a much greater benefit for the use of a lead apron for the fluoroscopy than for the ^99mTc.

There are a couple of extra things you can consider (and probably have) relative to the back strain. One is to find a two-piece apron so that half the weight of the apron is on your shoulders and half on your hips rather than all the weight being on your shoulders. Our pregnant staff prefer the two-piece. The other consideration—and I don't know how much control you have over this—is to limit the wearing of the apron to only when the fluoroscopy unit is on. I suspect, however, that the apron is probably under your sterile garb so it really is not an option.

A third possibility is a portable Plexiglas^TM 0.5 mm lead-equivalent shield. Our state regulations state that during fluoroscopy procedures a person in the room needs to be protected by, minimally, 0.5 mm lead-equivalent shielding. For you this might mean that you could step behind the portable shield during the intermittent fluoroscopy procedures and not need to wear an apron. If your organization has some portable shields, this might work for you. If you haven't seen one, it is simply a 30" wide by about 70" tall piece of leaded Plexiglas^TM on wheels.

There also needs to be some consideration for the use of the liquid radioactive materials as well. The concern here, since your protective garb is enough to prevent skin contamination, is the possibility of intake (like contaminated hands to the mouth). It is important to use standard precautions, prevent any spread of material, and survey yourself and others in the room after the procedures.

Kelly Classic
Certified Medical Health Physicist