Welcome to the Orthopaedic Surgery Radiation Protection Team’s Website. Here, we provide more insight into our novel approach to upper-body shielding against radiation. Our product aims to address the remarkable gap in the axillary region of the standard lead aprons currently used by female orthopedic surgeons to shield against radiation exposure in the Operating Room. This gap is particularly problematic for female surgeons because radiation exposure to the breasts’ ducts and lobules facilitates an increased risk of breast cancer (Chou et. al., 2012). To tackle this, our team has designed a three-layered radio-protective upper-body shield capable of providing axillary shielding while maintaining a wide range of motion due to its flexibility, and we will review this in detail below.
Current Hospital Scenario
With female orthopedic surgeons 85 % more likely to develop breast cancer compared to the general population, it was hypothesized that a large reason for this is the current standard of radiation garments worn during procedures (Chou et. al., 2012). Currently, all surgeons are suggested to wear a lead vest, which is placed both over the scrubs and rests on the surgeon’s shoulder blade, draping over the surgeon’s body. The only differential factor between female and male aprons is the sizing, failing to consider the anatomical and physiological differences between sexes. Without modifications in place, these aprons leave the axillary (side) breast tissue exposed, and combined with movements made during surgery, this area is left extremely vulnerable to x-ray radiation, causing the increased risk of cancer rate.
The problem with the current aprons
In addition to the axillary exposure, the current standard for radiation, lead, is a heavy material, which creates additional complications. Lead is traditionally the material of choice for radiation material as the cost is low and does not fluctuate. It is malleable, allowing the material to be incorporated into the apron, has strong x-ray attenuation and shielding properties due to its atomic number, density and electron configuration. However, many surgeons turn away from using this protective material as it is an additional burden during surgery due to its weight. As seen below, there is a gap in the axillary region of the lead apron, which exposes female orthopaedic surgeons in the operating room to unsafe working conditions.
Solving the Problem
The team has created a series of prototypes which have modeled radiation shielding in different ways. All prototypes include three layers: the outer and inner layers are fabric, and the middle layer is paneling of radiation shielding material (whether modeled or actual). The first and second prototypes consisted of only fabric layers to model how the garment will fit, where the third prototype focused on ideas of where the paneling should go. The fourth prototype finalized where the shielding panels will go, one panel on the upper breast tissue, and one large panel on the axillary tissue on each side.
The final prototype is currently being made. The inner layer which touches the customers skin is a dry fit polyester performance fabric with a sweat wicking element, and the outer layer is a cotton/ polyester blend. The panels will be inserted between these two layers by using velcro to secure them into pockets between the fabric. By using velcro to secure the panels, the shielding material will not move out of place, ensuring customer safety. There is also a plastic sportswear zipper in the front of the garment to allow for ease of putting it on and taking it off.
|Rank||Needs and Wants||Metric||Goal|
|N1||Radiation Shielding||Transmission ( % )||<30% radiation exposure to tissue (Hyun, 2016) (McAffrey, 2007)|
|N2||Thickness||Thickness (cm)||Balance between flexibility and transmission. Standard value = 0.5 mm. 0.3mm < Goal <1.0cm (McAffrey, 2007)|
|N3||Fit/Adjustability||Small/medium/large||Protective design which accommodates for varying body & cup sizes such as 32A through 40G: Small is sizes 0-2, medium is 4-8, and large is 10-12|
|N4||Flexibility||Young’s Modulus (Mpsi)||<13.8 Mps (AZoM, 2001)|
|N5||Light Weight||Density* (g/cm2)||< 11 g/cm2 (McAffrey, 2007)|
|N6||Cost-Effective||Dollars ($)||< $200 to purchase. Will not break easily so there is no need to continuously buy more products. (“Lead Aprons,” 2020)|
|W1||Hygiene||Garment covering||Detachable outer layer of garment, washable/disposable.|
|W2||Zipper||Thickness (cm)||Zipper is easy to grip and pull, not easy to break. An average sportswear zipper is 1cm across.|
|W3||Fabric||Type of fabric (cotton vs dri fit)||The fabric touching the skin should have a sweat-wicking element, and the fabric touching the shielding layer should be cotton.|
|W4||Aesthetics||Garment covering||Customisable outer layer – colors, logos, names, patterns, etc.|
The table above lists the most updated needs and wants of the customers concerning the design. These needs and wants are elaborated on in the menu below.
Needs are listed below from most to least important:
- Block the radiation from transmitting into the breast tissue-shield the surgeon from x-ray radiation greater than 100keV, which is the level present in most practices. Accomplished both in the overall thickness of the material (including cloth and lead material), and the total coverage of the affected area. The radiation-blocking element should be equivalent to that of lead or better.
- The material must be thick enough to block transmission, but thin enough to allow for flexibility.
- The material must fit well enough to completely cover the axillary area, yet allow for freedom of movement, specifically in shoulder abduction and adduction. This could be implemented by using elastic.
- The product must be lightweight to not bear pressure on the shoulders or back, allowing for comfortable working conditions.
- The product must have a v-neck as many hospitals will not allow a doctor to work if anything is peeking out of their scrubs, such as a T-shirt.
- A final need is that the product must be cost-effective, it should be available to hospitals with lower medical budgets and should be easy to mass produce in a factory to encourage more women to join the field of orthopedic surgery.
Wants are listed from most to least important:
- The product should be easily cleaned, aiding the hygiene of the medical professionals, which is incredibly salient during this time of the pandemic.
- The zipper which is used in the front of the garment should be thicker, as those used in sportswear, as these zippers do not break as easily as an invisible zipper, and have better grip.
- The fabric touching the customers’ skin should be dry fit to wick sweat away, and the fabric surrounding the radiation protection material should be cotton to save money.
- The product could incorporate an aspect of aesthetic appeal.
- This product should not be daunting to a medical professional of any level and should be easy to put on, adjust, and remove.
The Prototyping Process
The menu below elaborates on each of our prototypes, customer feedback of each prototype, as well as how the final prototype meets the needs and wants listed above.
This prototype was focused primarily on the general fit of the garment. Cotton T-shirts were sewn together with model shielding material secured in between with velcro.
- Very comfortable and did not bunch or shift when moving
- Liked the thick sports zipper
- Not cropped enough
This prototype incorporated two types of fabric and a minimalistic radiation protection design, only covering the axillary area. The shielding material was modeled with underarm guards.
- Liked the more cropped design
- Approved of model panel placement
This version of the garment had a sweat-wicking dry fit inner layer and a firm, cotton outer layer. This prototype also included Burlite radiation panels in the axillary area, covering the entire breast, and in the sleeves.
- Liked the duel layer and cropped design
- Did not like the sleeves as they might be too long for the scrubs
This prototype continued with the cropped design and incorporated an elastic cotton for the inner layer with the stiff cotton outer layer. This prototype replaced the idea of sliding the panels between the two layers with opening a flap or pocket to hook the panels in.
- Approved of where the panel sat in the axillary area
- Liked the idea of the pockets as they can see what they are doing instead of blindly sliding a panel between layers
- Liked the cap sleeves as these will not peek over the scrub sleeves and commented, “The less sleeve the better”, as they do not need radiation shielding in the sleeve
This version of the garment incorporated the layered design, but here the inner layer is a dry fit performance fabric, and the outer layer is a firm cotton. This prototype has cap sleeves as well, and includes three shielding panels on each side: one panel covering the front, upper breast, one covering the axillary area, and a third panel for the scapular area. The back panel is not necessarily needed, but is there for customer comfort. The panels are attached via pockets in the outer layer and are secured with velcro to ensure the panels will not slide and move around. The zipper is a sports performance zipper and this design includes a V-neck to make sure that it does not show when the customers are wearing their scrubs.
We have not yet received feedback on this prototype as of 5/5/2021
Final Prototype and Needs
- Radiation Attenuation: By incorporating Burlite paneling, this prototype protects the areas of concern from the X-rays.
- Thickness: The Burlite material is thick enough to block radiation as shown in the statistical table in the Testing section, but is not too thick to cause discomfort.
- Fit: The final prototype is comfortable to wear, and the performance fabric allows for some stretch. Sizing of the garment will be done in duel sizing: adjusting cup size and torso circumference.
- Flexibility: In addition to the performance fabric allowing for stretch, an elastic band can be sewn in the back of the outer layer for more elasticity and freedom of movement.
- Light Weight: The Burlite material used has a weight of 0.61lb/sq ft., and when wearing the garment, the weight is negligible.
- Cost effective: Due to the usage of a cheaper, cotton layer, the price is lower compared to two dry fit layers. Additionally, we are only covering a specific area with radiation shielding material, instead of the whole torso. We estimate the cost of manufacturing this product to be <$200.
Final Prototype and Wants
- Hygiene: The final prototype incorporates removable panels, allowing the fabric layers to be washed. It is recommended to wash in cold water and line dry to preserve the integrity of both the cotton and the performance fabric.
- Thick Zipper: The final prototype includes a thick, durable, sportswear zipper which is easy to grip and rarely catches on the fabric.
- Types of Fabric: The final prototype has the two types of material the customers wanted. The inner layer has a sweat wicking element and the outer layer is a firmer cotton.
- Aesthetics: This garment is hidden underneath the scrubs, so not much aesthetic appeal is needed; however, if this is developed further, a hospital logo could be easily sewn into the outer cotton layer.
Despite the radiation shielding material already having statistics on how well it prevents exposure, we are planning on testing our prototype in a room with scatter radiation to ensure the areas of concern are covered in the final design. The table below shows the statistics of each of the three materials we received for prototyping. The blue rows correspond to Burlite, which is the material we decided on incorporating into the final design.
Some things to consider moving forward are as follows:
- How will this design be picked up by a company?
- Can this concept be expanded so the orthopedic surgeons have no need for a lead apron?
- Can this design be modified in the future with a better shielding material?
Meet the Team