Gonadal Shielding Research Articles

Evaluation of Radiographers’ Knowledge, Attitudes, and Performance Regarding Gonadal Shielding in Diagnostic Radiology Examinations: Southern Khorasan Province Hospitals of Iran

Background: Nowadays, ionizing radiation is increasingly used in medicine. One of the most frequent X-ray examinations is pelvic radiography. Gonads are susceptible in the pelvic area. Gonadal shielding (GS) is a useful method to reduce the received dose by gonads. Despite the benefits of using gonadal shielding, it is rarely used by radiographers. Methods: This cross-sectional study was carried out in ten governmental hospitals with 300 radiographs. Results: The radiographers’ knowledge of using GS had a value equal to 59.1%. However, the radiographers did not have enough information on the subject, although their awareness about the significance of GS was acceptable. Conclusions: Although the radiographers believed in the necessity of using GS for pelvic, abdominal, and spine examinations, they used no shields.

Nonmyeloablative HLA-Identical Sibling Donor Transplantation for Children and Young Adults with Sickle Cell Disease: Interim Results of the SUN Multicenter Phase II Trial

Background: HLA-identical sibling hematopoietic stem cell transplant (HSCT) using myeloablative chemotherapy conditioning is a proven cure for sickle cell disease (SCD), but is associated with serious short and long-term toxicities. Additionally graft versus host disease (GVHD) can complicate care post-HSCT and contribute to mortality. Given these concerns many pediatric hematologists and families are reluctant to pursue HSCT for SCD. Nonmyeloablative HSCT resulting in stable mixed chimerism has been demonstrated to abrogate the SCD phenotype in adults. Data on outcomes of this approach to decrease toxicities and achieve cure in children remains scarce.Objective: To evaluate event-free survival (EFS), toxicity, health-related quality of life (HRQL), and transfusion burden among pediatric patients with SCD using a chemotherapy-free nonmyeloablative regimen.Methods/design: Children and young adults with SCD were prospectively enrolled in the Sickle transplant Using a Nonmyeloablative approach (SUN) multicenter clinical trial (NCT03587272). Six Sickle Cell Transplant Advocacy and Research Alliance (STAR) sites in the United States and Canada enrolled patients. The conditioning regimen consisted of alemtuzumab IV (0.03mg/kg on Day -7, 0.1mg/kg on Day -6, 0.3mg/kg on Days -5 to -3), low-dose total body irradiation with gonadal shielding (300 cGY on day -2), peripheral blood stem cells from an HLA-identical sibling, and sirolimus for at least one year. Baseline HRQL was compared with scores at day +30 and day +100 post-HSCT using the PedsQL and PROMIS measures. EFS was defined by any of the following events: death, graft failure (myeloid donor chimerism <10%), or GVHD.Results: All 30 of the patients planned for the primary endpoint of EFS have been enrolled. As of 7/20/2021, 24 patients are greater than 100 days post-HSCT with a median follow-up of 365 days (range 189-1105). The median age of this group at time of transplant was 13.5 years (range 2-22). All patients had neutrophil recovery (ANC >500/ul x 3 days) at a median of 21.5 days (range 0-29). Eleven patients (46%) did not require any platelet transfusions. Median transplant hospitalization was 16.5 days (range 14-43). Seven patients (29%) were again hospitalized (median 4 days, range 1-26). Three patients had secondary graft rejection at Day +71, +91, and +92 with no major complications and autologous recovery resulting in an EFS of 87.5% (Figure 1). Three additional patients have stable low donor chimerism (myeloid chimerism 11%, 38%, and 47%). The remaining 18 patients (75%) are disease-free and have robust donor engraftment (72-100% myeloid chimerism). Nine of these patients are >1 year post-HSCT and off sirolimus. Overall survival is 100% with no acute or chronic GVHD. Figure 2 shows total PedsQL scores during the peri-transplant time period. The median change in day +30 scores compared to baseline was 0 (IQR -7, +10), p=0.66. The median change in day +100 scores compared to baseline was +5 (IQR 0, +10), p=0.02.Conclusions: Outcomes of pediatric nonmyeloablative HLA-identical sibling HSCT for SCD appear similar to the larger adult experience with a GVHD-free, rejection-free survival of >80%. Importantly, patients have no worsening of their quality of life in the first month post-HSCT and already an improvement at day +100, suggesting that the short-term toxicities experienced by patients transplanted with this regimen are minimal. The majority of patients achieve disease resolution with no GVHD, but graft failure incidence appears higher than with myeloablative HSCT. Given the low intensity of this approach, a reasonable strategy may be to reserve myeloablation for a second transplant in the minority of patients who experience graft failure. [Display omitted] DisclosuresRangarajan: Medexus (Treosulfan): Consultancy, Honoraria. Guilcher: BlueBirdBio: Research Funding; Project Sickle Cure Study: Other: Principal Investigator, Research Funding. OffLabel Disclosure:alemtuzumab and sirolimus were used off-label as part of the studied transplant regimen

NCRP Statement No. 13 “NCRP Recommendations for Ending Routine Gonadal Shielding During Abdominal and Pelvic Radiography” and Its Accompanying Documents: Underpinnings and Recent Developments

NCRP Statement No. 13 “NCRP Recommendations for Ending Routine Gonadal Shielding During Abdominal and Pelvic Radiography” and Its Accompanying Documents: Underpinnings and Recent Developments

Bismuth Pelvic X-Ray Shielding Reduces Radiation Dose Exposure in Pediatric Radiography.

Background Radiation using conventional X-ray is associated with exposure of radiosensitive organs and typically requires the use of protection. This study is aimed at evaluating the use of bismuth shielding for radiation protection in pediatric pelvic radiography. The effects of the anteroposterior and lateral bismuth shielding were verified by direct measurements at the anatomical position of the gonads. Methods Radiation doses were measured using optically stimulated luminescence dosimeters (OSLD) and CIRS ATOM Dosimetry Verification Phantoms. Gonad radiographs were acquired using different shields of varying material (lead, bismuth) and thickness and were compared with radiographs obtained without shielding to examine the effects on image quality and optimal reduction of radiation dose. All images were evaluated separately by three pediatric orthopedic practitioners. Results Results showed that conventional lead gonadal shielding reduces radiation doses by 67.45%, whereas dose reduction using one layer of bismuth shielding is 76.38%. The use of two layers of bismuth shielding reduces the dose by 84.01%. Using three and four layers of bismuth shielding reduces dose by 97.33% and 99.34%, respectively. Progressively lower radiation doses can be achieved by increasing the number of bismuth layers. Images obtained using both one and two layers of bismuth shielding provided adequate diagnostic information, but those obtained using three or four layers of bismuth shielding were inadequate for diagnosis. Conclusions Bismuth shielding reduces radiation dose exposure providing appropriate protection for children undergoing pelvic radiography. The bismuth shielding material is lighter than lead, making pediatric patients more comfortable and less apt to move, thereby avoiding repeat radiography.

Japanese Translation of NCRP Statement No. 13 “NCRP Recommendations for Ending Routine Gonadal Shielding During Abdominal and Pelvic Radiography” and Its Accompanying Documents National Council on Radiation Protection and Measurements

Japanese Translation of NCRP Statement No. 13 “NCRP Recommendations for Ending Routine Gonadal Shielding During Abdominal and Pelvic Radiography” and Its Accompanying Documents National Council on Radiation Protection and Measurements

Multifiller nanocomposites containing gadolinium oxide and bismuth nanoparticles with enhanced X‐ray attenuation property

AbstractWe report here the development of multifiller nanocomposite containing gadolinium oxide and bismuth nanofillers with enhanced X‐ray attenuation property. The mass attenuation coefficient of the nanocomposite is found to be 5.26 (X‐ray attenuation: 95%) and 2.22 cm2/g (X‐ray attenuation: 71%), respectively, under dental and lung X‐ray scan conditions. Fourier transform infrared spectroscopy confirms the interfacial interaction between Gd2O3 nanofillers and the polymer matrix through hydrogen bonding. Atomic force microscopy images of the nanocomposite show a smooth and uniform topography with an average surface roughness of ~19 nm. Thermogravimetric analysis confirms the thermal stability of the nanocomposite upto 384°C. The enhanced X‐ray attenuation property of the nanocomposite is attributed to the good interfacial bonding, dual k‐edge effect of nanofillers and their uniform distribution within the polymeric matrix. Therefore, this nanocomposite is a promising material for diagnostic X‐ray shielding, especially as, thyroid collar, gonad shield, aprons, gloves, and so on.

Superior X-ray radiation shielding of biocompatible platform based on reinforced polyaniline by decorated graphene oxide with interconnected tungsten–bismuth–tin complex

Nowadays, upon rapid advances and developments in science and technology, X-ray radiation's role in diverse kinds of applications has been highlighted. Lead, and its derivatives as preliminary shielding systems are neither light nor biocompatible. Accordingly, the demand for the fabrication of a lead-free shielding system has increased over the past few decades. To surmount the limitations mentioned above, we have synthesized a novel X-ray radiation shield based on reinforced polyaniline with hybrid graphene oxide nanoflakes decorated with an interconnected complex of tungsten-bismuth-tin, which possesses high inhibitory effects against different microorganisms. Besides, diverse kinds of characterization techniques were employed to assess the as developed nanoflakes' successful fabrication. The radiation attenuation properties of developed nanomaterials and nanocomposites were explored using X-ray (i.e., 40, 60, 80, 100 and 120 keV) transmission measurements. The increasing thickness of the shield substantially developed the attenuation efficiency because thickening the samples would intensify the adequate number of the developed nanoparticles in the pathway of incident photons. The shield's thickest layer's attenuation efficiency and linear attenuation coefficient were 98.09% and 0.4399 1.mm-1, respectively, at the photon energy of 120 keV. The obtained results of the minimum inhibitory concentration (MIC) test and cell viability assay furtherly confirmed the favourable antibacterial/antifungal effects and non-toxic nature of the developed shields. According to the results, the developed shield can be effectively used to make lighter radiation protective clothes, e.g. aprons, gonad shields, thyroid shields, and structural shielding in X-ray facilities.

Canadian Society of Thoracic Radiology/Canadian Association of Radiologists Best Practice Guidance for Investigation of Acute Pulmonary Embolism, Part 1: Acquisition and Safety Considerations.

Acute pulmonary embolism (APE) is a well-recognized cause of circulatory system compromise and even demise which can frequently present a diagnostic challenge for the physician. The diagnostic challenge is primarily due to the frequency of indeterminate presentations as well as several other conditions which can have a similar clinical presentation. This often obliges the physician to establish a firm diagnosis due to the potentially serious outcomes related to this disease. Computed tomography pulmonary angiography (CTPA) has increasingly cemented its role as the primary investigation tool in this clinical context and is widely accepted as the standard of care due to several desired attributes which include great accuracy, accessibility, rapid turn-around time and the ability to suggest an alternate diagnosis when APE is not the culprit. In Part 1 of this guidance document, a series of up-to-date recommendations are provided to the reader pertaining to CTPA protocol optimization (including scan range, radiation and intravenous contrast dose), safety measures including the departure from breast and gonadal shielding, population-specific scenarios (pregnancy and early post-partum) and consideration of alternate diagnostic techniques when clinically deemed appropriate.

Installing oncofertility programs for common cancers in optimum resource settings (Repro-Can-OPEN Study Part II): a committee opinion.

PurposeThe main objective of Repro-Can-OPEN Study Part 2 is to learn more about oncofertility practices in optimum resource settings to provide a roadmap to establish oncofertility best practice models.MethodsAs an extrapolation for oncofertility best practice models in optimum resource settings, we surveyed 25 leading and well-resourced oncofertility centers and institutions from the USA, Europe, Australia, and Japan. The survey included questions on the availability and degree of utilization of fertility preservation options in case of childhood cancer, breast cancer, and blood cancer.ResultsAll surveyed centers responded to all questions. Responses and their calculated oncofertility scores showed three major characteristics of oncofertility practice in optimum resource settings: (1) strong utilization of sperm freezing, egg freezing, embryo freezing, ovarian tissue freezing, gonadal shielding, and fractionation of chemo- and radiotherapy; (2) promising utilization of GnRH analogs, oophoropexy, testicular tissue freezing, and oocyte in vitro maturation (IVM); and (3) rare utilization of neoadjuvant cytoprotective pharmacotherapy, artificial ovary, in vitro spermatogenesis, and stem cell reproductive technology as they are still in preclinical or early clinical research settings. Proper technical and ethical concerns should be considered when offering advanced and experimental oncofertility options to patients.ConclusionsOur Repro-Can-OPEN Study Part 2 proposed installing specific oncofertility programs for common cancers in optimum resource settings as an extrapolation for best practice models. This will provide efficient oncofertility edification and modeling to oncofertility teams and related healthcare providers around the globe and help them offer the best care possible to their patients.

Result of Online Survey on Gonadal Shielding in Pediatric Hip and Pelvic Radiography: Task Group of Gonadal Shielding in Pediatric Hip and Pelvic Radiography, Radiation Protection Division, Japanese Society of Radiological Technology

Result of Online Survey on Gonadal Shielding in Pediatric Hip and Pelvic Radiography: Task Group of Gonadal Shielding in Pediatric Hip and Pelvic Radiography, Radiation Protection Division, Japanese Society of Radiological Technology

Effect of Silicone Rubber-Lead (SR-Pb) Thickness on Dose Reduction and Image Quality as Gonad Shield.

Background: Some organs in the body are sensitive to radiation such as eyes, breast, and gonads. Protection of sensitive organs against radiation is necessary. Recently, many sensitive organ shields have been developed from different materials.Objective: The aim of this study is to evaluate the dose reduction and image quality from implementation of Silicone Rubber-Lead (SR-Pb) as an alternative gonad shield in digital radiography (DR).Material and Methods: In this experimental study, the SR-Pb gonad shields with various thicknesses of 2, 4, 6, 8, and 10 mm were synthesized. This study used the Pb percentage of 5 wt%. An anthropomorphic phantom was used in abdomen plain examinations. The results obtained from the use of the SR-Pb was compared with standard gonad shield, i.e. lead apron. To measure the dose reduction, the Piranha detector was used. The image quality assessment was evaluated with the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR). Results: This study showed the dose reduction was significant for all SR-Pb thicknesses, and incrementally increased with the increase of the SR-Pb thickness. The minimum and maximum of dose reduction were 22.8% for 2 mm and 66.9% for 10 mm SR-Pb, respectively. Conclusion: Compared to the reference image without gonad shield, the SNR and CNR do not significantly change. Hence, the SR-Pb is probably to be used as an alternative gonad shield.

Systematic Review: Puberty suppression with GnRH analogues in adolescents with gender incongruity.

Gender incongruence is defined as disharmony between assigned gender and gender identity. Several interventions are liable in this case including genital affirming surgery among other surgical interventions such as harmonization, and also the use of gonadotropin-releasing hormone agonists (GnRHa) for gonadal shielding. This aids in preventing the development of secondary sexual characteristics related to the genetic sex. Systematically review the treatment of gender incongruity with GnRHa analogues. The data source of this research is from Pubmed-Medline and Embase. Articles published between 2009 and 2019 which studied transgender adolescents treated with GnRHa were carefully selected. Were extracted: design, sample size, study context, targeted subjects of intervention, outcome measures, and results. Eleven studies were included. The use of GnRHa seems to be well tolerated by the studied population. When started in pubertal transition, it was associated with a more distinct resemblance to body shape than to the affirmed sex. In addition to preventing the irreversible phenotypic changes that occur in cross-hormonal therapy, the use of GnRHa can equally contribute to the mental health of these adolescents. There are few consistent studies on the use of GnRHa for gender incongruence. As the population of transgender children and adolescents grows, they acquire knowledge and greater access to the various forms and stages of treatment for sex reassignment. The medical community needs to be adequately prepared to better serve this population and offer the safest resources available.

Achievable dose reductions with gonadal shielding for children and adults during abdominal/pelvic radiographic examinations: A Monte Carlo simulation

Recently, medical professionals have reconsidered the practice of routine gonadal shielding for radiographic examinations. The objective of this study was to evaluate the gonadal dose reduction achievable with gonadal shields in the primary beam during abdominal/pelvic radiographic examinations under ideal and non-ideal shielding placement. CT scans of CIRS anthropomorphic phantoms were used to perform voxelized Monte Carlo simulations of the photon transport during abdominal/pelvic radiographic examinations with standard filtration and 0.1mm Cu+1mm Al added filtration to estimate gonadal doses for an adult, 5yr old, and newborn phantom with and without gonadal shields. The reduction in dose when the shields were not placed at the ideal locations was also evaluated. The ratio of the number of scattered-to-primary photons (SPR) across the anteroposterior (AP) dimension of the phantoms was also reported. The simulated dose reduction with ideal shielding placement for the testes and ovaries ranged from 80% to 90% and 55% to 70% respectively. For children, a misalignment of the shield to the gonad of 4cm reduced the measured dose reduction to the gonads to <10%. For adults, this effect did not occur until the misalignment increased to ~6cm. Effects of dose reduction with and without the gonadal shields properly placed were similar for standard filtration and added filtration. SPR at the level of the testes was consistently <1 for all phantoms. SPR for ovaries was ~1.5 for the adult and 5-yr old, and ~1 for the newborn phantom. Dose reduction with ideal alignment of the simulated gonadal shield to the gonads in this study was greater for the testes than the ovaries; both reductions were substantial. However, the dose reductions were greatly reduced (to <10%) for both sexes with misalignment of the gonads to the shields by 4cm for children and 6cm for adults.

Impact of gonad shielding for AP pelvis on dose and image quality on different female sizes: A phantom study

IntroductionIn clinical practice AP pelvis standard protocols are suitable for average size patients. However, as the average body size has increased over the past decades, radiographers have had to improve their practice in order to ensure that adequate image quality with minimal radiation dose to the patient is achieved. Gonad shielding has been found to be an effective way to reduce the radiation dose to the ovaries. However, the effect of increased body size, or fat thickness, in combination with gonad shielding is unclear.The goal of the study was to investigate the impact of gonad shielding in a phantom of adult female stature with increasing fat thicknesses on SNR (as a measure for image quality) and dose for AP pelvis examination. MethodsAn adult Alderson female pelvis phantom was imaged with a variety of fat thickness categories as a representation of increasing BMI. 72 images were acquired using both AEC and manual exposure with and without gonad shielding. The radiation dose to the ovaries was measured using a MOSFET system. The relationship between fat thickness, SNR and dose when the AP pelvis was performed with and without shielding was investigated using the Wilcoxon signed rank test. P-values < 0.05 were considered to be statistically significant. ResultsOvary dose and SNR remained constant despite the use of gonad shielding while introducing fat layers. ConclusionThe ovary dose did not increase with an increase of fat thickness and the image quality was not altered. Implications for practiceBased on this phantom study it can be suggested that obese patients can expect the same image quality as average patients while respecting ALARA principle when using adequate protocols.

Quantification of Increased Patient Radiation Dose When Gonadal Shielding Is Used With Automatic Exposure Control.

Quantification of Increased Patient Radiation Dose When Gonadal Shielding Is Used With Automatic Exposure Control.

Human Ovarian Cortex biobanking: A Fascinating Resource for Fertility Preservation in Cancer.

Novel anti-cancer treatments have improved the survival rates of female young patients, reopening pregnancy issues for female cancer survivors affected by the tumor treatment-related infertility. This condition occurs in approximately one third of women of fertile age and is mainly dependent on gonadotoxic protocols, including radiation treatments. Besides routine procedures such as the hormonal induction of follicular growth and subsequent cryopreservation of oocytes or embryos, the ovarian protection by gonadotropin-releasing hormone (GnRH) agonists during chemotherapy as well as even gonadal shielding during radiotherapy, other innovative techniques are available today and need to be optimized to support their introduction into the clinical practice. These novel methods are hormone stimulation-free and include the ovarian cortex cryopreservation before anti-cancer treatments and its subsequent autologous reimplantation and a regenerative medicine approach using oocytes derived in vitro from ovarian stem cells (OSCs). For both procedures, the major benefit is related to the prompt recruitment and processing of the ovarian cortex fragments before gonadotoxic treatments. However, while the functional competence of oocytes within the cryopreserved cortex is not assessable, the in vitro maturation of OSCs to oocytes, allows to select the most competent eggs to be cryopreserved for fertility restoration.

The impact of gonad shielding in anteroposterior (AP) pelvis projections in an adult: A phantom study utilising digital radiography (DR)

IntroductionPositioning relative to the lateral automatic exposure control (AEC) chambers (cranial/caudal orientation) optimises dose and image quality in pelvic radiography. In the cranial orientation introducing gonad shielding (GS) in females may increase radiation dose. The aim of this study was to fully optimise the combination of pelvis orientation and use of GS in both male and females. MethodsAn anthropomorphic pelvis phantom was exposed, with dose area product (DAP) recorded, in both orientations without GS and four conditions with GS: cranial orientation (female/male), caudal orientation (female/male). A 4 cm × 4 cm grid incorporating thirteen positions for the GS resulted in 52 experimental settings. Blind image quality assessment, utilising a modified scale, was undertaken by two experienced observers. ResultsComparing no GS (caudal orientation) to female GS, no significant change in DAP was seen (3.97 v 4.03 dGy*cm2; Mann–Whitney p = 0.060). Comparing no GS (cranial orientation) to male GS no significant change in DAP was seen (8.66 v 8.77 dGy*cm2; Mann–Whitney; p = 0.210). DAP increased significantly with introduction of female GS in the cranial orientation (23%: 8.66 v 10.65 dGy*cm2, Mann–Whitney; p < 0.001) and male GS in the caudal orientation (22.8%: 3.97 v 4.87 dGy*cm2, Mann–Whitney; p < 0.001). Significantly higher repeat rates (Chi-squared test; p < 0.001) were seen for GS in female (85–100%) compared to male (30.8%). ConclusionThe use of gonad shielding can increase DAP and lead to repeats being required, with more required for female GS usage, suggesting the utility of GS for pelvis examinations is questionable. Implications for practiceOptimisation of radiation dose in pelvic radiographic examinations utilising AEC terminated exposures requires consideration of AEC chamber position and GS usage.

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

ObjectiveAs gonad shielding is currently under debate, this study evaluates the practice, from its introduction in about 1905 until today.MethodsThe 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.ResultsIn 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.ConclusionsAssessment 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.

Polymer nanocomposites containing β‐Bi2O3 and silica nanoparticles: Thermal stability, surface topography and X‐ray attenuation properties

AbstractSilicone polymer‐based nanocomposites containing β‐Bi2O3 nanoparticles with varying concentrations of silica nanoparticles are successfully prepared and characterized for thermal stability, surface topography, and X‐ray attenuation property. Of all the samples studied here, silicone polymer of higher density (S1) containing β‐Bi2O3 (50 wt%) and silica (0.025 wt%) nanoparticles is found to be thermally stable upto 424 and 375°C in argon and oxygen atmosphere, respectively. The atomic force microscopy image of top and cleaved surface of this nanocomposite exhibits an average roughness of 12 and 506 nm, respectively. It also exhibits the highest X‐ray attenuation property, among the samples analyzed here, against X‐rays of energies in the range of 30–66 keV. Therefore, S1 silicone polymer containing β‐Bi2O3 and silica (0.025 wt%) nanoparticles is a potential material for the development of lead‐free and X‐ray opaque aprons, gloves, thyroid collar, gonad shield, and so on.

Prevalence of Shielding in Diagnostic X-ray Centers in the Islamic Republic of Iran: A Systematic Review

Shielding has been recommended as an effective tool against radiation exposure. Several studies have published on the availability and use of shielding tools in diagnostic X-ray centers across the country and contradictory results been reported. Therefore, the aim of this systematic review was to find out the status of radiation protection in term of availability and use of shielding tools in diagnostic X-ray centers in Iran. An extensive literature search was conducted in the PubMed/Medline, Embase, ISI, Cochrane Library, SID, Magiran, IranMedex, Irandoc and Google-Scholar search engine. We also manually searched the reference lists of the relevant studies. Two authors independently assessed the eligibility of all studies and extracted data. Thirty-seven studies published from 1998 to 2019 were included in this systematic review. In all, 1089 diagnostic X-ray centers, 4439 radiographs and performance of 1472 radiographers were covered in these studies. The availability of lead apron, gonad shield and thyroid collar were ranged from 7 to 95.5%, 26.6 to 94% and 7 to 94%, respectively. Moreover, their usage was ranged from 0 to 85.5%, 0 to 35% and 0 to 38.4%, respectively. In addition, lens shield was discussed in one study with availability of 0%. During 1998 to 2019, the status of shielding had not improved across the country. Therefore adherence to the safety guideline as far as possible is required to protection patients from undue exposure to radiation.