Using Personal Protective Equipment

Although dental staff use personal protective equipment (PPE) such as disposable gloves, gowns, and protective eyewear on a daily basis, this is primarily for infection control purposes. During routine radiographic procedures, providing staff are either standing a suitable distance away from the X-ray tube head and patient, or behind shielding, and are not in the path of any intra oral primary X-ray beams, the potential for exposure will be negligible and there will be no need for any additional, radiation specific, PPE. However, there may be times when PPE is necessary to adequately restrict the exposure of staff.

When To Use PPE

The need, or otherwise, for PPE to protect employees, and what type of PPE is appropriate, must be determined as part of the radiation risk assessment. A couple of examples are discussed below.

1. It is sometimes necessary for a person to remain in close proximity to the patient during exposures. This could be to provide reassurance (to young children for example) or other forms of support (such as for patients with additional needs who may be unable to hold the image receptor in position). Such support should usually only be provided by the patient’s parent, guardian or other accompanying adult and the operator should refer to their employer’s procedure ‘dose constraints and guidance for carers and comforters’ (see step 4.9 for further information on all the employer’s procedures required by IRMER17). However, there may be occasions when this is not possible, and a member of staff is required to help. Safe working procedures should be specified in the risk assessment, but if there is further scope to restrict exposure, then the risk assessment may conclude that wearing of PPE (such as a protective apron) is necessary.
2. When working with hand-held dental X-ray equipment it is important to keep the X-ray beam in the horizontal plane to restrict the dose to the operator from scattered X-rays. However, there may be occasions when this is not possible (such as the patient being unable to position themselves appropriately due to mobility issues). In this case, the risk assessment should consider:

• If it is practicable to use fixed X-ray equipment instead, which will permit a greater range of X-ray beam directions to be used
• Whether doses to employees can be adequately restricted by following safe working procedures
• If there is a need for PPE in addition to safe working procedures, to restrict the X-ray exposure of employees as far as is reasonably practicable

The practice should always consult its RPA when drafting or revising its risk assessment.

The Protective Lead Apron

Should the risk assessment identify that PPE is required, a lead apron would normally be used. Although there are several styles (one example is shown here), they all utilise thin sheets of high-density material (usually lead with a minimum thickness of 0.25 mm) to attenuate X-radiation, reducing the dose received by the wearer.

Other forms of PPE such as thyroid collars and lead shielded spectacles are not necessary for employees involved in dental radiography, as the potential for exposure from scattered radiation from the patient is very low.

Storage of Lead Aprons and Checks on Their Condition

Protective lead aprons must be stored appropriately when not in use, e.g. by hanging them on rails of sufficiently large diameter to avoid creasing the shielding material, as creases could develop into cracks over time. For the same reason, protective lead aprons should never be stored folded. Each apron should be visually examined for cracks in the protective material, and the results recorded, at least once a year. Any apron showing signs of damage should be replaced.