At Salem Health, we do all we can to ensure our patients receive the best quality imaging exam with as little radiation dose as possible. A recent change to best practice may prompt your patients to ask for more information about shielding and why it is no longer used during X-ray exams.
The information below shares the motivation and science behind this change, and concludes with some very useful FAQs.
Historically, patient shielding has helped reduce radiation exposure to sensitive areas on the body such as the gonads. However, equipment has advanced and recent science have shown that shields offer no protective benefit and actually carry risk of higher or repeat exposures!
Gonadal shielding was introduced in the 1950s due to concerns for hereditary effects from radiation (if parent gonads are irradiated, future children will inherit DNA mutations). This effect was observed in plants and fruit flies! Many studies have followed groups exposed to high amounts of radiation such as the atomic bomb survivors, and this effect has never been seen in humans.
Digital X-ray equipment at Salem Health adjusts dose per each patient (pediatric or adult) and tailors exposure to body region (hand vs abdomen).
It does this using sensors in the digital imaging plate which cut off exposure when enough x-rays reach the detector to form a diagnostic quality image. When thick lead shielding is placed on this sensor the equipment will increase dose.
Studies over the last decade have also shown that despite best efforts, shields are very frequently misplaced or inadvertently moved by the patient during exams. They may obscure desired anatomy rendering the study non-diagnostic (wasted dose) or requiring a repeat exposure (double dose!).
In light of these findings, national radiation science organizations have recommended discontinuation of gonadal shielding for best patient dose reduction, which is done by the equipment itself without interference.
The 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.
Accordingly, the State of Oregon Health Authority (Radiation Protection Services) removed the requirement for gonadal shielding from the administrative rules this January.
To respond quickly and do what’s best for our patients, we have already begun to implement this change and have rounded with Imaging (SH, WVH, Skyline, Woodburn) and ED staff. 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 our Technologists, Radiologists, Imaging Physicist (Anna Mench) or Imaging Manager (Justin Millar).
A reminder that staff or parents of patients 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 (shield won’t interfere).
Another reminder: We also do not shield in CT because, like the sensors in x-ray, current CT machines adjust for the person on the scanner before the exam. Any dense lead in the beam increases dose dramatically!
Please see the links below for FAQ prepared by the AAPM CARES Committee and let us know if you, your staff, or your patients have any questions!
Gonadal shielding FAQ:
https://www.aapm.org/org/policies/documents/CARES_FAQs_Patient_Shielding.pdf
Committee website: