Current State of Gonadal Shielding in Medical Imaging: A Review

Abstract

Introduction In recent times the benefits of using gonadal shielding have been brought into question. Several professional bodies have released positional statements in support of ceasing the use of gonadal shields. However, in Australia the regulatory authority for radiation has not commented to date. This literature review aims to explore the risks and benefits of using lead protection and to establish the current state of the use of gonadal shields in clinical practice. Methods A search of the literature was conducted using online databases under the subject “Medical Imaging and Radiation Sciences”. Key terms and phrases included “lead protection”, “plain film imaging”, “lead shielding”, “gonadal shielding”, “X-ray”, “radiography”, “pelvic radiography”, “radiation protection”, “methods”, “education” and “gonadal shielding”. Articles pertaining to radiation therapy, literature reviews and those not in English were excluded. Results and Discussion Gonad shields are often poorly used despite agreement of what constitutes accurate and inaccurate shielding. Inaccurate shielding relates to both inappropriate size and inaccurate positioning of shields. Retrospective studies demonstrated a higher incidence of inaccurate gonadal shield placement in females compared to males. Inaccurate shielding had implications for patients such as obscuration of important anatomy and pathology and increased radiation dose if repeat X-rays were required to correct positioning errors. Shield design innovation was identified as a future area of research that could assist with overcoming these errors. Where gonad shielding was found to be of benefit in patients with conditions that require regular follow-up imaging. This is especially important in conditions affecting children and adolescents who have increased radiosensitivity and longer life expectancy. Conclusion Studies have demonstrated high incidence of inaccurately positioned gonad shields for female patients, which leads to repeated X-ray images and increased dose to patients. However, shielding has been shown to be beneficial for patients requiring frequent X-ray examinations to reduce cumulative radiation dose. Establishing a standardised protocol regarding the application of gonadal shields, supported by regulatory agencies, is imperative.