Inadequate Protection: Current Radiation PPE is Failing to Shield Female Healthcare Workers

Adequate protection cannot be guaranteed by standard personal protective equipment for breast tissue; employers should invest in protective gear that ensures the safety of all employees.

In an article published recently in The BMJ, doctors advocate for improved ionizing radiation protection for women in healthcare who are regularly exposed to radiation through X-rays and other imaging procedures, in order to reduce their risk of developing breast cancer.

Due to the high sensitivity of breast tissue to radiation and the fact that ionizing radiation is a well-established human carcinogen, there are apprehensions that frequent exposure to ionizing radiation during image-guided procedures could increase the likelihood of female healthcare workers developing breast cancer.

Personal protective equipment (PPE) such as lead gowns are used to shield the body from harmful radiation during these procedures. But studies have shown that current radiation PPE provides inadequate protection to breast tissue as it leaves the area close to the armpit (known as the upper outer quadrant and axilla — the most common site of breast cancer) exposed.

“Providing adequate breast covering PPE could therefore reduce radiation exposure and potentially help prevent breast cancer in female healthcare workers,” write Isobel Pilkington and colleagues.

They acknowledge that measuring the risk of occupational radiation-induced breast cancer in women working in healthcare is challenging, but as the number of female trainees entering these specialties increases, they say “it is essential that the available evidence is considered and equipment provision improved to minimize this risk.”

They point to observational evidence suggesting an increase in breast cancer risk among female US orthopedic surgeons compared with an age-matched female population, and to a small Finnish study showing breast cancer at 1.7 times the expected rate in radiologists, surgeons, and cardiologists compared with female physicians not working with radiation.

In a study using artificial female torsos to measure radiation exposure, researchers found inadequate upper outer quadrant protection and no statistically significant reduction in dose when standard PPE was compared with a torso without PPE.

Occupational radiation exposure has not been identified as a risk factor for male breast cancer. However, the Ionising Radiation Regulations 2017 state that the radiation dose delivered to all workers should be As Low As Reasonably Achievable (ALARA). The most effective way to achieve this, say the authors, is by reducing the duration of exposure, increasing the distance from the source, and shielding all workers with effective PPE.

They point to additional protection, such as capped sleeves and axillary wings, that can be worn under standard gowns to protect the upper outer quadrant of the breast, and say the European Society for Vascular Surgery 2023 Clinical Practice Guidelines on Radiation Safety have already recommended female operators consider adopting this extra protection.

“Providing appropriate protection is a legal requirement of an employer, who has a duty of care to all workers exposed to radiation,” they write. “The female breast appears to be particularly vulnerable and it is, therefore, important employers invest in protective equipment that enhances the safety of all their staff.”

Reference: “Protecting female healthworkers from ionising radiation at work” by Isobel Pilkington, Hannah Sevenoaks, Emily James and Deborah Eastwood, 12 April 2023, The BMJ.

DOI: 10.1136/bmj-2023-075406