Evaluation of lead equivalence and integrity of personal radiation protective equipment using multiple imaging modalities

Personal radiation protective equipment (PRPE) play a critical role in minimising occupational exposure to ionising radiation in medical imaging, nuclear medicine, interventional procedures and related fields. Over time, repeated use, mechanical stress, and improper handling can degrade their protective performance, making regular inspection essential to ensure continued radiation safety. This study aimed to compare the performance of multiple imaging modalities in evaluating the integrity and lead equivalence of PRPE, to identify the most accurate and practical methods for quality assurance programmes. Over a four-year period, 1063 PRPE items from 20 manufacturers were evaluated. Each item underwent visual and tactile inspection, followed by imaging using radiography, fluoroscopy, computed tomography (CT), and a dedicated PRPE testing system (FLOWD 8020). Lead equivalence was determined by comparison with certified reference lead foils using both x-ray quality assurance dosimeter and image-based methods. Integrity was categorised on a four-level scale according to defect size and location, and attenuation performance was assessed relative to manufacturers' nominal specifications. Of all PRPE items tested, 88.8% were defect-free, while 11.2% showed cracks or tears cracks or tears of varying extent. Lead equivalence results revealed that 74.3% met specifications within ±5%, 13.8% deviated by 5%-10%, and 11.9% by more than 10%. All imaging modalities demonstrated comparable accuracy, though the dedicated screening system offered clear advantages in workflow efficiency, full-apron coverage, automated reporting, and low stray dose (<0.3<i>μ</i>Sv h^-1at 1 m). Routine PRPE inspection is essential for maintaining occupational radiation safety. Standardised testing protocols and inspection intervals are recommended to ensure consistent and traceable quality assurance practices across institutions.