Lead aprons are a key tool used by many medical and dental practitioners to protect patients from harmful, extraneous X-rays during fluoroscopic procedures. Because of the aprons' lead content, the Joint Accreditation for the Commission of Healthcare, or JACOH, requires that practitioners inpect all of their lead aprons on a regular basis. Inspection assesses the thickness, lead exposure and coverage area of the apron. Frequency of inspection is at the sole discretion of the practitioner, and standards vary among states. To determine these standards, many states, hospitals and research organizations use the widely cited "Practical Rejection Model" of Drs. Pillay and Stam of Medical Center Haaglanden in the Netherlands. Inspections can be performed either visually or by X-raying the apron to determine smaller signs of deterioration.
Tears of more than 27.0 cm in length, regardless of the apron size or thickness, are cause for rejection. Smaller perforations or cracks in the edges can result in rejection as well, depending on the length and width of the apron as compared to the size of the defect. Taking an X-ray of the apron is often the only way to detect smaller breaks or cracks along the sides.
Thinning of the lead and the outer protective layer of the apron also warrants rejection. Thinning is the result of prolonged use, and creates a floppy, comparatively lightweight apron that can expose the patient to lead. Thinning is determined by measuring thickness in relation to the size of the apron.
Irreparably broken Velcro warrants an inspection failure. Each lead apron is designed to protect different areas of the body. For example, an apron used at a dentist's office is high around the neck to ensure complete coverage of the thyroid gland. Broken Velcro will cause the unsecured apron to slide downward, exposing the gland to harmful X-rays, and is therefore not acceptable.