Female gonadal shielding with automatic exposure control increases radiation risks

Kaplan, Summer L.; Magill, Dennise; Felice, Marc; Xiao, Rui; Ali, Sayed; Zhu, Xiaowei

doi:10.1007/s00247-017-3996-5

Cited by 37 publications

(27 citation statements)

References 26 publications

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“…Several studies pointed to inadequate placement of gonad shields, the concomitant loss of diagnostic information and the low doses currently involved, but were cautious with their advice. A few suggest reconsidering or ending the practice in female children [6][7][8][9][11][12][13], in male children [7,9,12] or in all [3,10]. Marsh and Silosky are more outspoken when referring to the officially still endorsed practice of gonad shielding as "…the folly of its continued use…" [4].…”

Section: Discussionmentioning

confidence: 99%

“…The ICRP (2013) [1] and IAEA (2018) [2] endorse this practice, whereas others, such as the Dutch guidelines [3], Marsh and Silosky [4] and the AAPM [5], no longer recommend it. Other authors dismiss gonad shielding partly or express their doubts about existing benefits [6][7][8][9][10][11][12][13]. This debate should ideally be decided by a quantitative analysis based on proper knowledge of radiation risks, reduction in hereditary risk by gonad shielding and the increase in risk caused by negative side-effects of shielding.…”

Section: Introductionmentioning

confidence: 99%

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Gonad shielding in pelvic radiography: modern optimised X-ray systems might allow its discontinuation

et al. 2020

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Objective: As gonad shielding is currently under debate, this study evaluates the practice, from its introduction in about 1905 until today. Methods: The literature was searched for developments in shielding and insights into the effects of ionising radiation on gonads. Based on own pre-1927 dose reconstructions, reported doses after 1927, a 2015-report from the European Union and recent own measurements, the effects of technological evolution and optimisation on radiation dose and hereditary risk were assessed. Results: In the 1900s, gonad shielding was first applied to prevent male sterility, but was discontinued when instrumental developments led to reduced radiation doses. In the 1950s, concerns about hereditary risks intensified and gonad shielding was recommended again, becoming routine worldwide. Imaging-chain improvements over time were considerable: in 2018, the absorbed dose was 0.5% of its 1905 value for the testes and 2% for the ovaries, our optimised effective dose a factor five lower than the value corresponding to the current EU diagnostic reference level, and the reduction in detriment-adjusted risk by shielding less than 1 × 10 −6 for women and 5 × 10 −6 for men. Conclusions: Assessment of pelvic doses revealed a large reduction in radiation risks facilitated by technological developments. Optimisation likewise contributed, but unfortunately, its potential was never adequately exploited. Today, using a modern and optimised X-ray system, gonad shielding can be safely discontinued for women. For men, there might be a marginal benefit, but potential negative side-effects may well dominate. Discontinuation of gonad shielding seems therefore justifiable.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gonad shielding in pelvic radiography: modern optimised X-ray systems might allow its discontinuation

et al. 2020

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“…Kaplan et al [26] investigated on whether a gonadal shielding may affect the automatic exposure control (AEC) response. They showed that female gonadal shielding combined with AEC during pelvic radiography increases absorbed dose to organs with greater radiation sensitivity and to unshielded ovaries.…”

Section: Gonadal Shieldingmentioning

confidence: 99%

Protecting sensitive patient groups from imaging using ionizing radiation: effects during pregnancy, in fetal life and childhood

et al. 2019

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The frequency of imaging examinations requiring radiation exposure in children (especially CT) is rapidly increasing. This paper reviews the current evidence in radiation protection in pediatric imaging, focusing on the recent knowledge of the biological risk related to low doses exposure. Even if there are no strictly defined limits for patient radiation exposure, it is recommended to try to keep doses as low as reasonably achievable (the ALARA principle). To achieve ALARA, several techniques to reduce the radiation dose in radiation-sensitive patients groups are reviewed. The most recent recommendations that provide guidance regarding imaging of pregnant women are also summarized, and the risk depending on dose and phase of pregnancy is reported. Finally, the risk-benefit analysis of each examination, and careful communication of this risk to the patient, is emphasized.

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“…Often, efforts to reduce patient dose using gonadal shields actually increase dose because inadequate coverage of the gonads or the obscuration of critical anatomy may result in a repeated x ray. Even if the shield is correctly placed on the anatomy, the automatic exposure control phototiming cells may be covered, leading to increased radiation output of 63% for pediatrics to 147% for adults …”

Section: For the Proposition: Sarah Mckenney Phdmentioning

confidence: 99%

“…Additionally, shielding does not protect the patient from internally scattered radiation. Depending on the patient size, scattered radiation can substantially contribute of the radiation dose delivered to the ovaries . While we strive for equality in healthcare, gonadal shielding is nothing more than good intentions for the female population.…”

Section: For the Proposition: Sarah Mckenney Phdmentioning

confidence: 99%

Gonadal shielding should be discontinued for most diagnostic imaging exams

McKenney

Gingold

Zaidi³

2019

Medical Physics

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Female gonadal shielding with automatic exposure control increases radiation risks

Cited by 37 publications

References 26 publications

Gonad shielding in pelvic radiography: modern optimised X-ray systems might allow its discontinuation

Gonad shielding in pelvic radiography: modern optimised X-ray systems might allow its discontinuation

Protecting sensitive patient groups from imaging using ionizing radiation: effects during pregnancy, in fetal life and childhood

Gonadal shielding should be discontinued for most diagnostic imaging exams

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