Change Your World Week Winter 2022 (Archived)

'"Radiography' means the making of a film or other record of an internal structure of the body by passing x-rays or gamma rays through the body to act on film or another image receptor." (Wakeman)

"The goal of modern radiation protection programs is to protect persons from both short-term and long-term effects of radiation. Radiation protection may be defined as effective measures employed by radiation workers to safeguard patients, personnel, and the general public from unnecessary exposure to ionizing radiation." (Statkiewicz-Sherer)

Along with time and distance, shielding is a Cardinal Rule of Radiation Protection. Shielding is used to cover specific areas of the body that are more sensitive to radiation. The area typically covered is the gonadal regions of both male and female patients. This shielding is made of lead which absorbs the x-ray photons during the exposure.

    *Lead Apron                                                      *Gonadal Shielding                          *Mobile Lead Protective Barrier            

~ AAPM & NCRP - The American Associate of Physicists in Medicine and the National Council on Radiation Protection both support the position that “removes the specific requirement for gonadal shielding when the gonads are in the primary beam area. Protective aprons should continue to be provided for personnel to wear while operating mobile x‐ray equipment.” (IDPH) The AAPM also states that the use of shielding "during X-ray based diagnostic imaging may obscure anatomic information or interfere with the automatic exposure control of the imaging system.” (Governance) 

~ JRCERT - The position of the Joint Review Committe on Education on Radiologic Technology is that "gonadal shielding does not contribute significantly to reducing patient risk from radiation exposure and, when positioned improperly, may have the unintentional consequence of increasing patient exposure and may result in the loss of valuable diagnostic examination results." (JRCERT) Research collected from abdominopelvic radiographic studies has led the JRCERT to "conclude that routine use of gonadal shielding for abdominopelvic radiography exams should not be standard practice for clinical radiography students when the use of such could interfere with the diagnostic quality of the exam and may result in the risk of a repeat exposure." (JRCERT)

~ ASRT - The position of the American Society of Radiologic Technologists is that we should continue to use shielding during exams that do not require shielding in the abdominopelvic region. "For example, the placement of a lap shield during a radiographic extremity procedure carries little-to-no risk of exam interference or error, but may significantly increase patient comfort and confidence, thus helping to reaffirm our profession’s commitment to maximizing safety. The elimination of all patient shielding from standard practice could exacerbate the radiophobia that exists among the public and our patients due to widespread media coverage of the published risks associated with medical radiation exposure." (ASRT)

- ARRT - The position of the American Registry of Radiologic Technologists is that "health care institutions may adopt varying degrees of gonadal and fetal shielding recommendations, schools with imaging programs should teach students about shielding and the effects of fetal and gonadal radiation exposure, and students and R.T.s have the ethical responsibility to act in the best interests of each patient." (ARRT)

Pros to removing the shielding: 

• Less chance of having to repeat the exam due to coverage of pertinent anatomy which increases the dose to the patient.
• Less chance that coverage of AEC chambers with the shield would mess with the AEC controls and overexpose the patient.
• For male patients, the shield may be too small to fully cover the gonads.
• Patients may not want you to touch or be near their gonadal region when placing the shield on them, which may cause them to refuse the shielding.

Cons to removing the shielding:

• Patients who are nervous or anxious may feel more comfortable knowing they are being shielding.
• Slight increase to patient dose due to no absorption from the lead which increases substantially when a series, or multiple, exams/views are needed.

1)Shield covers bone structures    2)Too small & too high for a female patient     3)Correct size & placement

~ Educating the technologist - Radiologic technologists must be educated on how to protect the patient, family, other health care workers, and themselves especially in a trauma situation. Any nurses, physicians, or staff members who cannot leave the trauma patient, must be provided with a lead apron/shield. “Under no circumstances should an exposure take place with an unshielded person in the vicinity of the primary beam. The ALARA principle applies to other health care workers and the public, in addition to the patient.” (Lampignano & Kendrick) When performing mobile radiography, you are not only exposing the patient, but also yourself, staff, and family members if they are not provided with the proper instructions or shielding. Patient's families should be instructed to leave the room along with other staff members who can leave the patient. The technologist should be wearing a lead apron and stand at least six feet away if possible. Technologists should also be educated on how to protect pregnant patients with shielding if the exam is absolutely required and how, if required by clinical location, to properly position a gonadal shield without obscuring pertinent anatomy.

~ Educating the patient & family - We strive to "educate our patients and health care colleagues on the recent advances in technology that have dramatically reduced patient radiation dose, as well as the indispensable role those radiologic technologists serve in the provision of safe and high-quality medical imaging procedures." (ASRT) The patient should know that shielding is no longer recommended, and that if used or positioned improperly, may cover up anatomy that the radiologist wants to view, and a repeat exam may need to be taken. The family, especially of younger, pediatric patients should be made aware that the amount of radiation received in most diagnostic x-ray exams carries little to no risk.

1. The benefit of not wearing shielding in the abdominal or pelvic region during diagnostic x-ray exams outweighs the risk of exposing the gonads.
2. In order to cause temporary sterility or infertility, the dose to a patient's gonadal region would have to be significantly larger than what is required for any regular diagnostic x-ray exam.
3. Radiologic equipment and technology continues to improve which reduces the likelihood of having to expose patients multiple times and keeps the dose As Low As Reasonably Achievable, or ALARA.
4. Recent research has led to the understanding that gonads are not as radiosensitive as they once were thought to be. They were originally thought to have a tissue weighting factor, basically a sensitivity level, of .2 and are now considered a .08.
5. Even though shielding absorbs a small amount of x-ray photons, it very rarely affects the amount of scatter produced in the patient which may hit the gonads even though covered externally.

• “ARRT Issues Statement on Gonadal and Fetal Shielding.” ARRT, https://www.arrt.org/pages/arrts-position-on-gonadal-and-fetal-shielding.

• Bing Images, Microsoft, https://www.bing.com/images/details/%7B0%7D.

• “Governance.” AAPM Position Statements, Policies and Procedures - Details, American Association of Physicists in Medicine, 2019, https://www.aapm.org/org/policies/details.asp?id=2552.

• IDPH. FS for Diagnostic Radiology Applications Gonadal Shielding. Bureau of Radiological Health,   https://idph.iowa.gov/Portals/1/userfiles/305/FS%20for%20Diagnostic%20Radiology%20Applications%20Gonadal%20Shielding.pdf.

• “JRCERT POSITION STATEMENT ON GONADAL SHIELDING IN THE CLINICAL SETTING.” JRCERT, Joint Review Committee on Education in Radiologic Technology, 7 Mar. 2022, https://www.jrcert.org/?pg=1.

• Lampignano, John P., and Leslie E. Kendrick. “Chapter 15.” Bontrager's Textbook of Radiographic Positioning and Related Anatomy, 10th ed., Elsevier, St. Louis, MO, 2021, pp. 573–576.

• “News, Research and Publications News Room.” ASRT Update on Gonadal and Fetal Shielding, ASRT, 15 Jan. 2021, https://www.asrt.org/main/news-publications/news/article/2021/01/15/asrt-update-on-gonadal-and-fetal-shielding.

• Statkiewicz-Sherer, Mary Alice, et al. Radiation Protection in Medical Radiography. 9th ed., Mosby, 2022.

• Wakeman, et al. House Bill No. 5103. Michigan Legislature, 24 June 2021, https://www.legislature.mi.gov/documents/2021-2022/billintroduced/House/pdf/2021-HIB-5103.pdf.