Gonadal shielding in X-ray no longer a best practice
Evidence shows shields offer little benefit, higher exposure risk
By Anna Mench, PhD, DABR, diagnostic imaging physicist, RSO
At Salem Health, we do all we can to ensure our patients receive the best quality radiation exam with as little radiation as possible! Historically, patient shielding has been one way to help reduce radiation exposure to sensitive areas on the body such as the gonads and has been used for decades. However, equipment has advanced and scientific evidence has recently brought to light that shields offer little (if any benefit) and actually carry risk of higher exposures.
Gonadal shielding was initially introduced in the 1950s due to concerns for hereditary effects from radiation (if parent gonads are irradiated, future offspring will inherit DNA mutations). Many studies have followed groups exposed to even high amounts of radiation such as the atomic bomb survivors, and this effect has NEVER been seen in humans. Current digital X-ray equipment (what we have at Salem Health) now adjusts the dose per each patient (pediatric or adult) and body region (hand vs. abdomen).
It does this using sensors in the digital imaging plate. When lead shielding is placed on this sensor, the equipment will increase the dose!
Studies over the last decade have brought to light that shields are frequently misplaced or inadvertently moved during many routine X-ray exams. They obscure anatomy the radiologist needs to see to make a diagnosis. This means the study is non-diagnostic (wasted dose) or it needs to be repeated (double dose!)
In light of these findings, national radiation safety organizations have recommended discontinuation of gonadal shielding for best patient dose reduction, which is done by the equipment itself without interference.
American College of Radiology, Health Physics Society, the Image Gently campaign and the American Association of Physicists in Medicine have put out statements and/or recommendations to cease gonadal and fetal shielding during X-ray exams.
The State of Oregon Radiation Protection Services repealed the requirement for gonadal shielding just last week. In an effort to respond quickly and do what’s best for our patients, we have already begun to implement this change.
Our X-ray technologists — who are experts in these matters, along with our radiologists and physicist — are prepared to field questions from patients and staff alike. If you have any questions please reach out to imaging physicist Anna Mench at firstname.lastname@example.org or 503-814-1366, or imaging manager Justin Millar at Justin.email@example.com or 503-814-1227.
A reminder that staff or parents in the room during X-ray will still be shielded from external scatter, as they receive no benefit from the medical imaging exam, and are not in the X-ray field. In addition, we also do not shield in CT because the machines take a snapshot of the person on the scanner before the exam. Any lead in the beam mimics a large patient and increases dose dramatically!
Thank you for your support and patience as we work through this important, beneficial change brought to you by science!