Study on the use of gonadal protection shields during paediatric pelvic X-rays

Abstract

Background: There are national guidelines issued by all hospital radiology departments concerning the use of gonadal protection shields for taking X-rays of the pelvis. It is important to follow these guidelines especially when paediatric X-rays are taken. Gonads are very susceptible to radiation as they fall directly in the line of radiation exposure when pelvic X-rays are taken. Aim: To examine whether these guidelines were being followed. Methods: This audit considered 355 radiographs taken in a 6-month period on 149 patients, under the age of 16 years, attending the orthopaedic department at King's Mill Hospital. Results: In only 23% of the cases studied, the correct use of gonad protection shields had been performed. In 67% of the unprotected patients, the shields were not used at all. In the remainder, the shield was incorrectly applied. Out of all the patients, 45% had more than one X-ray thus exposing the gonads to unnecessary radiation. In addition, 8% of patients had a CT scan, 6% had fluoroscopy and 42% had radiographs of other regions of the body. Conclusions: Guidelines should be adhered to as far as possible and efforts always be made to decrease radiation exposure. Application of the current guidelines excludes the first X-ray exposure of the female pelvis and of the pelvis of trauma patients from the use of shields, thus adding to the number of the X-rays done without protection.

Gonad Shielding for Patients Undergoing Conventional Radiological Examinations: Is There Cause for Concern?

“…The associated risks following the exposure of such a large population due to the stochastic and non-stochastic effects of ionization radiation created a global concern (2). According to ALARA (as low as reasonable achievable) recommendations, no dose of radiation is safe (3). The gonads in the pelvic region are highly sensitive to radiation (with a tissue weighting factor of 0.08), which indicates the high potential for hereditary and malignant damage resulting from radiation exposure (4).…”

“…Shielding is one of the fundamental methods by which to protect radiosensitive organs such as the gonads (5). Various studies have been carried out to evaluate gonad shielding during radiological examinations using pelvic radiographs (3,4,6), questionnaires (7) and direct observation (8). Gonadal shields are divided into contact and shadow shields.…”

More harm than good? The anatomy of misguided shielding of the ovaries

“…The placement of such modern shields is often inaccurate, and an unfortunate consequence of misplacement is obscuration of critical orthopaedic landmarks [12][13][14][15][16]18]. The application of shields can be especially difficult in children.…”

“…Since the original description (in this journal in 1958) of a lead shield for gonadal protection in female patients undergoing pelvic radiography, the design and use of such shields has been the subject of numerous publications [12][13][14][15][16][17][18]. Most often the reports are of ineffective gonad protection.…”

Preliminary study on the practice of gonad shielding during pelvic radiography

“…In addition, protecting the gonads of children is of particular importance during diagnostic imaging of the pelvis lower abdomen or proximal femur, since evidence suggests that X-rays could cause direct damage to the gonad which could result in mutation [5]. Using gonad shielding during diagnostic X-ray procedures is: an effective way of reducing the risk of genetic effects in future generations [6], may be quite effective to lower the dose to the tests (95%) than females (50%) ovaries [7,8].…”