Gonadal Shielding Research Articles

Gonadal shielding technique to preserve fertility in male pediatric patients treated with total body irradiation for stem cell transplantation.

Advances in hematopoetic stem cell transplantation (HSCTC) for the management of pediatric genetic disorders and malignancies have resulted in a growing population of adult survivors. With increased survival, current attention has now focused on improving treatment-related morbidities and quality of life for pediatric patients undergoing HSCTC. Infertility is one of the most common late effects and causes significant psychosocial problems for many pediatric patients, as well as for their family members.

유아기 여아의 생식선 차폐체 제작을 위한 골반 지표 계측

It was performed in this study to provide basic information on production of accurate gonadal shield by measuring pelvic indicators of TDP SD ISP IAD 1CDP and 2CDP. when pelvis ap and hip ap examination was taken, there is no exact position of the reference point of the shield and anatomically more difficult to shield gonad in the case of female infants than male. Results analyzed by height in 70~80 and 110~120 were approximately 30mm 13mm 19mm 20mm 2mm and 7mm difference in TDP SD ISP IAD 1CDP and 2CDP respectively. This value was statistically significant (P 0.05). the difference was nearly about 1mm. Analysis of results by weight of less than 10 and more than 20 showed difference on TDP SD ISP IAD 1CDP and 2CDP by 28mm 14mm 11mm 20mm 3mm and 8mm. it was statistically significant (P<0.05). From the above results, female infants pelvic indicator measurement can be used as reference value for shielding production and especially IAD can present a reference point on the shielding position. Pelvis indicators of female infant has a close correlation. In addition, as it is showen in the statistical difference analysis to have an accurate ovarian shield, gonad shield would be produced and used by height, age and weight.

Gonad Protection During Paediatric Abdomen and Pelvic X-Ray Examinations

Background: Evidence suggests that children are more susceptible to radiation risks or hazards. In particular, their gonads are more sensitive to the effects of radiation, especially at or below reproductive age. Protecting the gonads of children and adults is of particular importance to the imaging. Aim: To investigate level of the use of gonad protection during paediatric abdomen and pelvic X-ray examinations in the Accra metropolis. Method: A quantitative, descriptive and cross sectional survey were applied where systematic random sampling was used to select five hospitals from Accra Metropolis (Ghana) that provided radiological services and had permanent radiographers. Three different tools were used in the study for data collection: observation, questionnaire and evaluation of pediatric radiographs of abdomen and pelvis. Results: A total of 44 out of 46 Radiographers recruited in five hospitals completed the questionnaire and were also involved in the observational study. The study achieved a 95.65% response rate. It was identified that 46% (n=20) of the radiographers reported they had no gonad shields in their department. Few departments (13%) had no shields at all and 39% (n=17) of the respondents applied gonad shields only on male sexes. Although there were no laid down policies in the departments surveyed 55% of the respondents reported they were aware of policies regarding the use of gonad shields. Conclusion: It appears that there are no standardised national policies on radiation protection in general for hospitals to follow and so it is absent in the imaging departments. This has affected the availability of gonad shields and adherence to its application to protect patients. To improve quality diagnostic imaging service, there is the urgent need for management to pay serious attention to patient protection especially children against unnecessary exposure to ionising radiation during X-ray procedures. Hospital management must communicate the relevant policies and local rules concerning radiation protection in particular the use of gonad shield to protect children.

Shielding during x-ray examination of pediatric female patients with developmental dysplasia of the hip

Patients with developmental dysplasia of the hip (DDH) generally undergo multiple x-ray examinations of both hip joints. During these examinations, the gonads are completely exposed to radiation, unless shielded. Although many types and sizes of gonad shields exist, they often do not provide adequate protection because of size and placement issues; additionally, these shields are frequently omitted for female patients. Our aim was to assess gonad protection during x-ray examination that is provided by gonad shields designed for individual female patients with DDH.We retrospectively retrieved data from the Picture Archiving and Communication System database; pelvic plain x-ray films from 766 females, 18 years old or younger, were included in our analysis. Based on x-ray measurements of the anterior superior iliac spine, we developed a system of gonad shield design that depended on the distance between anterior superior iliac spine markers. We custom-made shields and then examined shielding rates and shielding accuracy before and after these new shields became available. Standard (general-purpose) shields were used before our custom design project was implemented. The shielding rate and shielding accuracy were, respectively, 14.5% and 8.4% before the project was implemented and 72.7% and 32.2% after it was implemented. A shield that is more anatomically correct and available in several different sizes may increase the likelihood of gonad protection during pelvic x-ray examinations.

Incorrectly placed gonad shields: Effect on CT automatic exposure correction from four different scanners

PurposeTo examine the influence of incorrectly placed gonad shields on radiation dose when performing abdominal CT with automatic exposure correction, using systems from different vendors. Methods and materialsAn anthropomorphic phantom was scanned without gonad shields, and with gonad shields placed in two different positions relative to the scan range. Dose Length Product was recorded. mA distribution in the longitudinal direction was plotted. Mean dose was compared using the t-test. ResultsThree scanners showed different increase in relative DLP according to shield position. ConclusionCare must be taken when placing lead shielding at CT and characteristics of each scanner should be known to the operator.

Gonad shielding in paediatric pelvic radiography: Effectiveness and practice

The use of Gonad Shields (GS) has been advocated during pelvic radiography since the 1950's, particularly in children where the risks from radiation are higher. Previous literature reports that GS are often omitted and rarely used correctly. ObjectivesPresentation of findings concerning use of GS in the context of previous data in the literature, and recommend any appropriate actions. MethodA retrospective analysis of images from an existing DICOM Digital Teaching Library (DTL) was conducted. Images of the pelvis from paediatric patients were reviewed and scored on whether a GS was present and (if present) whether the shield was considered to adequately protect the gonads. Results130 images were reviewed. 70 male and 60 female. The gonads were deemed to be protected by a shield in 22 images (17%), inadequately protected when a shield was used in 44 images (34%) with the remaining 64 images (49%) having no shield at all. A lack of adequate protection for the gonads was found, with females more likely to be inadequately protected than males (χ2 = 19.009, df = 1, p < 0.001). These findings become more clinically significant when reports of ovaries lying outside of the pelvic basin (in paediatric patients) are considered. ConclusionsThe current practice of gonad shielding is neither effective nor beneficial for female paediatric patients, incorrect shield placement can often require repeat exposures. This finding is commensurate with previous literature. Therefore, gonad shielding is no longer an appropriate optimization tool for female paediatric patients during conventional radiography of the pelvis, and should be abandoned.

Oncofertility in Canada: Gonadal Protection and Fertility-Sparing Strategies

Background: Cancer can be a devastating diagnosis. In particular, malignancy and its indicated treatments have profoundly negative effects on the fertility of young cancer patients. Oncofertility has emerged as a new interdisciplinary field to address the issue of gonadotoxicity associated with cancer therapies and to facilitate fertility preservation. In Canada, fertility issues are often inadequately addressed despite the availability of resources. The goal of this four-part series is to facilitate systemic improvements in fertility preservation for adolescent and young adult Canadians with a new diagnosis of cancer. Methods: Here, we review the fertility preservation measures currently available. Medical and surgical strategies are both outlined. Results: Fertility-preserving strategies and gonadal protection have demonstrated variable success in a number of approaches. The value of hormone suppression is still in question for women. Progestins for endometrial cancer and alternative chemotherapies are other medical approaches. Gonadal shielding and protective surgical approaches have also been attempted. Conclusions: The techniques discussed here may be selectively considered and integrated into patient care in an attempt to preserve future fertility before initiating cancer treatment.

Efficacy of gonadal shielding in pediatric pelvis X-rays

In this study, we evaluated the efficacy of using gonadal shielding in pediatric patients. Between October 2011 and February 2012, 1137 pelvic X-rays of 675 consecutive patients (323 boys, 352 girls; mean age 6.8 years; range 6 month to 17 years) in our hospital were evaluated in terms of gonadal shielding use by a team including an orthopedist, a gynecologist and a pediatrician. Gonadal shields were used in 566 (49.8%) pelvic X-rays of 1137 patients and important anatomical landmarks were left open in 506 (44.5%) of them. In 104 (9.1%) X-rays, the shields were placed in correct position. It was observed that a total of 293 (25.7%) X-rays were partially protective, while 109 (9.6%) X-rays were placed in a totally wrong position. Nineteen X-rays (3.3%) were repeated due to malposition of the gonadal shielding. In X-rays of boys, gonadal shields were used for 193 (17%); however only 74 (6.5%) of them were placed in correct position. In X-rays of girls, gonadal shields were used for 373 (32.8%); however only 30 (2.6%) of them were protective. If we take into consideration that use of pelvic X-rays is essential and indispensable for the diagnosis of many pediatric pelvic diseases, we believe that technicians who are responsible for taking these X-rays should be better trained on the use of gonadal shields and designs of gonadal shields should be improved.

Gonadal shielding for neonates

Gonadal shielding for neonates

Assessment of concomitant testicular dose with radiochromic film

To assess the suitability of EBT2 and XRQA2 Gafchromic film for measuring low doses in the periphery of treatment fields, and to measure the accumulative concomitant dose to the contralateral testis resulting from CT imaging, pre-treatment imaging (CBCT) and seminoma radiotherapy with and without gonadal shielding. Superficial peripheral dose measurements made using EBT2 Gafchromic film on the surface of water equivalent material were compared to measurements made with an ionisation chamber in a water phantom to evaluate the suitability and accuracy of the film dosimeter for such measurements. Similarly, XRQA2 was used to measure surface doses within a kilovoltage beam and compared with ionisation chamber measurements. Gafchromic film was used to measure CT, CBCT and seminoma treatment related testicular doses on an anthropomorphic phantom. Doses were assessed for two clinical plans, both with and without gonadal shielding. Testicular doses resulting from the treatment of up to 0.83 ± 0.17 Gy were measured per treatment. Additional doses of up to 0.49 ± 0.01 and 2.35 ± 0.05 cGy were measured per CBCT and CT image, respectively. Reductions in the testicular dose in the order of 10, 36 and 78% were observed when gonadal shielding was fitted for treatment, CT and CBCT imaging, respectively. Gafchromic film was found to be suitable for measuring dose in the periphery of treatment fields. The dose to the testis should be limited to minimise the risk of radiation related side effects. This can be achieved by using appropriate gonadal shielding, irrespective of the treatment fields employed.

Relative distribution of pertinent findings on portable neonatal abdominal radiographs: can we shield the gonads?

Shielding of the gonads is a dose-saving strategy in pediatric radiography and its use is the law in New York and the majority of other states. However, routine use of gonadal shields is controversial because of concerns that important diagnostic information can be obscured. The purpose of this study was to assess the frequency and spatial distribution of key findings on portable neonatal abdominal radiographs. We reviewed the 2,544 portable neonatal intensive care unit anteroposterior abdominal radiographs performed in 2010 at a university medical center, of which 962 were inadequately shielded. These 962 radiographs were reviewed by pairs of pediatric radiologists for the presence of findings in different regions, including bowel abnormalities, pneumatosis, free air, inguinal hernias, osseous abnormalities, and catheter/tube tips. The fewest pertinent findings were present below the level of the sacrosciatic notches (n = 181, 18.8%). Of the 853 abnormalities below the level of the iliac crests in our cohort, six were isolated to these regions, whereas others had concomitant abnormalities more superiorly. Of 35 radiographs with pneumatosis or suspected pneumatosis in the pelvis, 33 had pneumatosis in more superior regions. Suspected free air was never isolated to the pelvis. Osseous abnormalities were only present in the pelvis below the sacrosciatic notch, and 37.5% of lower extremity catheters terminated below the level of the sacrosciatic notches. Pertinent findings on neonatal intensive care unit abdominal radiographs are rarely isolated to the pelvic regions.

Trauma Patients’ Satisfaction on Radiographers Management Based on Standard Operational Procedures in X-Ray Facilities Cagayan De Oro City

Progress of human social awareness depends on man’s ability to communicate with one another. In a hospital setting, whose primary concern is life, wherein some factors may cause a patient’s anxiety and fear. Health personnel therefore, should take time to give comfort to patient, find greater personal satisfaction in work, and quality of care. The study was conducted in radiologic facilities of Cagayan de Oro City involving radiologic technologists and trauma patients brought to the clinics. The study used sampling procedure in a form of the questionnaire and interview to gather imperative data’ both quantitative and qualitative. Pertinent data gathered from the respondents were tabulated to simplify and organize the results. Surveys and interviews conducted and researchers’ profound data analysis resulted to the following findings: The extent of the trauma patient satisfaction on radiographer’s management based on standard operational procedures in x-ray facilities. Patients were found to be satisfied with the clinical operating procedure in terms of positioning, protection, communication, instruction, waiting time and patient care, except for application of gonadal and thyroid shield, self-introduction of radiographers, patient information on the procedure to be done, care to be administered and time to answer patient questions should be given attention for improvement of services. KEYWORDS - Patients care, Positioning, Communication, Patient’s satisfaction, Radiologic Technologist and X-ray Technologists.

Radiation dose reduction effectiveness of a male gonadal shield during 128-MDCT using Glass Detector

Abstract When abdomen and pelvic were scanned with 128 channel MDCT, the gonadal exposure dose was measured with and without gonadal shield and the obtained images were evaluated. As a result, during abdominal MDCT scan, the gonadal exposure dose was measured 16.5±0.5 mGy when the gonad shield was not used, and it was 7.5±0.3 mGy when the large gonad shield(650 m 2 ) was used, which showed the effect of reduction in the gonadal exposure dose by 54%. During pelvic MDCT scan, the gonadal exposure dose was 9.5±0.3 mGy when the gonad shield was not used, and it was 2.8±0.2 mGy when the large gonard shield(650 m 2 ) was used, which showed the effect of reduction in the gonadal exposure dose by 70%. The images were obtained when using the gonad shield and when not using it during MDCT scan, and as a result of analyzing them with 5-point Likert scale, in the abdominal image, it was 4.1 points irrespective of whether using the gonad shield or not. And also, in pelvic scan, it was 1.2 points when the gonad shield was used, and 4.1 points when it was not used. With the results above, it is considered that during the abdominal 128-MDCT scan, by using the gonad shield, the images should be obtained without being degraded and the exposure dose must be reduced.

Patient Radiation Dose Assessment in Pelvic X-ray Examination in Ghana

Protecting the gonads of children and adults is of particular importance during diagnostic imaging of the pelvis since evidence suggests that X-rays could cause direct damage to the gonad which could result in mutation. Gonad shielding during diagnostic X-ray procedures is an effective way of reducing dose to patients’ reproductive organs and reduces the risk of genetic effects in future generations. Given the potential harmful effects associated with exposure to ionizing radiation, it is important not just to provide gonad shielding, but also to measure patient doses, and reduce them where possible. The aim of this study was to provide patient dose estimates for pelvic examination being undertaken at selected diagnostic centers in Ghana as a baseline data for pelvic dose optimization in Ghana. Dose measurements were calculated on 323 patients (137 (42%) male, 186 (58%) female, ages, 38.56 yr ± 9.0; range 20–68). The Entrance Surface Dose (ESD) was determined by an indirect method, using the patient’s anatomical data and expo¬sure parameters utilized for the specific examination. The Quality Assurance Dose Database software (QADDs) developed by Integrated Radiological Services Ltd. in Liverpool, UK was used to generate the ESD values. There were variations in the technique factors used in all the centers as compared to the recommendations in the European Commission (EC) quality criteria. Eighty percent of the hospitals recorded lower ESD values below IAEA recommended diagnostic reference levels (10 mGy) and 40% of the hospitals exceeded the UK national reference value (4 mGy). The varia¬tions in the data recorded demonstrate the importance of creating awareness by the radiographic staff on quality assurance and standardization of protocols to ensure satisfactory standards and optimized radiation dose to patients and staff.

Assessment of radiation protection practices among radiographers in Lagos, Nigeria.

Background:Use of ionising radiation in diagnostic radiography could lead to hazards such as somatic and genetic damages. Compliance to safe work and radiation protection practices could mitigate such risks. The aim of the study was to assess the knowledge and radiation protection practices among radiographers in Lagos, Nigeria.Materials and Methods:The study was a prospective cross sectional survey. Convenience sampling technique was used to select four x-ray diagnostic centres in four tertiary hospitals in Lagos metropolis. Data were analysed with Epi- info software, version 3.5.1.Results:Average score on assessment of knowledge was 73%. Most modern radiation protection instruments were lacking in all the centres studied. Application of shielding devices such as gonad shield for protection was neglected mostly in government hospitals. Most x-ray machines were quite old and evidence of quality assurance tests performed on such machines were lacking.Conclusion:Radiographers within Lagos metropolis showed an excellent knowledge of radiation protection within the study period. Adherence to radiation protection practices among radiographers in Lagos metropolis during the period studied was, however, poor. Radiographers in Lagos, Nigeria should embrace current trends in radiation protection and make more concerted efforts to apply their knowledge in protecting themselves and patients from harmful effects of ionising radiation.

A questionnaire study about gonadal shield use of urologists

Amac: Amacimiz Turkiye'de gonad kalkani kullanma konusunda urologlarin dikkat, farkindalik ve hassasiyet duzeylerini belirlemektir. Gerec ve yontem: Bu amacla 15 sorudan olusan bir anket formu hazirlandi. Bu formlar bir ulusal uroloji kongresine katilan urologlara dagitildi. Toplam 271 katilimcidan yuz yuze gorusme sonucu elde edilen veriler incelendi. Bulgular: 271 katilimcidan 33'u profesor, 36'si docent, 36'si yardimci docent, 94'u uzman ve 81'i asistan idi. Katilimcilarin %22'si bu konuda daha once gonad kalkani hakkinda, bilgi sahibi degildi. %44'u tip fakultesinde, %14'u asistanlik doneminde ilk kez bilgi sahibi olmustu. %64 katilimci gonad kalkani konusunda hicbir makale okumamisti. %54'u ise daha once hicbir gonad kalkani modeli gormemisti. %82'si hastanelerinde boyle bir aparatin olmadigini veya kullanmadiklarini belirtti. %18'i ise gonad kalkani kullandiklarini belirtti. Urologlarin %80'i ''kendinizi ve meslektaslarinizi gonad kalkani kullanma konusunda yeterince dikkatli ve hassas buluyor musunuz? '' sorusuna hayir cevabini verdi. Sonuc: Turkiye'deki urologlar arasinda gonad kalkani kullanma konusunda farkindalik ve hassasiyet yeterli duzeyde degildir ve bu yuzden kullanimi yaygin degildir. Urologlar gonad koruyucu araclar hakkinda urolojik akademik platformlar tarafindan bilgilendirilmelidir.

A New Practical Model of Testes Shield: The Effectiveness During Abdominopelvic Computed Tomography

The goal of our prospective study was to measure the effect of a new standard model male gonad shield on the testicular radiation exposure during routine abdominopelvic computed tomography (CT). Two hundred male patients who underwent upper abdominal and pelvic CT examinations were included in our study. To prepare the testes shield (TS), 2 No. 8 fluoroscopy radiation-protection gloves made of bismuth (0.35 mm lead equivalent) were used. These gloves were invaginated into one another and their fingers were turned inside out. Scrotums of all patients were pushed into these lead-containing gloves. Upper abdominal CT (n = 6), pelvic CT (n = 9), and abdominopelvic scanning (n = 185) were performed. Immediately after the CT examinations and at postprocedural day 1, the scrotal examinations were repeated. None of the patients exhibited scrotal laceration, edema, eruption, erythema, tenderness, or pain. During the CT examinations, 22 patients (11%) felt unrest because of their exposed genital regions, without any adverse effect on the procedure. Dosimetric measurements of radioactivity inside the TS (dosimeter I) and outside it (dosimeter II) were 6.8 and 69.00 mSv, respectively. Accordingly, the TS we used in our study reduced the radiation exposure of the testes by 90.2% (10.1 times). We think that the use of this radioprotective TS during radiological diagnostic and therapeutic procedures is an appropriate approach from both a medical and legal perspective. Therefore, we recommend this userfriendly, practical, low-cost, and effective TS for all radiologic procedures.

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

Popular gonad shield designs aim to provide coverage of the true pelvis, which is presumed to be the probable location of the ovaries. Shields are frequently placed inaccurately, especially in children, obscuring important orthopaedic landmarks on pelvic radiographs. We aimed to identify the position of the ovaries and asses how this may vary with age and the degree of bladder filling. We aimed to identify the position of the ovaries and asses how this may vary with age and the degree of bladder filling. Using MRI examinations of the pelvis in women and children, we located 594 ovaries in 306 female patients aged from birth to 59 years. This study provides new evidence that bladder filling affects ovary position. A lower than expected number of patients had both ovaries within the pelvis if the bladder contained more than a moderate volume of urine. Bladder emptying should be achieved wherever practical if a shield is used. In children under the age of 7 years, more than half (19/37) had at least one ovary outside the true pelvis. There was a significant association between age and ovary position, with the percentage of patients with one or both ovaries outside the true pelvis decreasing with age (χ(2), p<0.0001). The embryological descent of the ovaries into the pelvis would appear to continue after birth, well into childhood. Current popular shield designs are therefore inappropriate for use in young children. Given the high risk of obscuring critical landmarks, coupled with the new evidence that even accurate placement will not necessarily protect the ovaries, the use of pelvic shields in girls should be reconsidered.

Attitudes of medical imaging technologists on use of gonad shielding in general radiography

AbstractPurpose: Gonad shielding is an important way to address the ‘as low as reasonably achievable’ (ALARA) requirement in radiography. However, its use relies on the attitudes of medical imaging technologists (MITs) to consistently adhere to professional conduct requirements relating to the application of gonad shielding. The purpose of this study was to investigate the attitudes of Western Australian (WA) MITs to the use of gonad shielding in general radiography and also to explore the variables influencing these attitudes. Methods: A questionnaire regarding MITs' attitudes towards gonad shielding was developed based on relevant literature and distributed to MITs working in general radiography employed by public and private clinical centres in WA metropolitan and rural regions. Descriptive (percentage of frequency, mean and standard deviation) and inferential statistics (chi‐square, t‐test and analysis of variance) were used to analyse the responses of the multiple choice (MC) and 5‐point scale questions from the returned questionnaires. Results: The questionnaire response rate was 44.6% (127/285). It was found that WA MITs perceived gonad shielding as important (mean: 3.8) and that adequate education had been provided (mean: 3.1). However, statistically significant attitude variations existed among MITs from different employment sectors (P &lt; 0.01), equipment awareness (P &lt; 0.05), genders (P &lt; 0.005) and educational qualifications (P &lt; 0.05). Conclusion: Overall, WA MITs have positive and appropriate attitudes to the use of gonad shielding in general radiography. However, statistically significant attitude variations existed among MITs. Possible directions for improvement include the provision of gonad shielding protocol in each x‐ray room in clinical departments and the enhancement of education and training of shielding application. This potentially will lead to improved consistency in the appropriate application of gonad protective shielding.

Fertility Preservation in Female Cancer Patients

With improved survival rates among cancer patients, fertility preservation is now being recognized as an issue of great importance. There are currently several methods of fertility preservation available in female cancer patients and the options and techniques via assisted reproduction and cryopreservation are increasing, but some are still experimental and continues to be evaluated. The established means of preserving fertility include embryo cryopreservation, gonadal shielding during radiation therapy, ovarian transposition, conservative gynecologic surgery such as radical trachelectomy, donor embryos/oocytes, gestational surrogacy, and adoption. The experimental methods include oocyte cryopreservation, ovarian cryopreservation and transplantation, in vitro maturation, and ovarian suppression. With advances in methods for the preservation of fertility, providing information about risk of infertility and possible options of fertility preservation to all young patients with cancer, and discussing future fertility with them should be also considered as one of the important parts of consultation at the time of cancer diagnosis.