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What’s New in the Patient Safety World

June 2021

No More Lead Aprons for Patients?

 

 

The time-honored procedure of shielding patients’ gonads from radiation with lead aprons during diagnostic radiology exams has come to an end. In January 2021 both the American College of Radiology (ACR 2021) and the National Council on Radiation Protection and Measurement (NCRP 2021) announced that routine gonadal shielding during abdominal and pelvic radiography is no longer recommended.

 

Gonadal shielding has been used since the 1950’s with the rationale that it prevented radiation damage to reproductive organs and consequent heritable genetic defects. The NCRP statement notes that the risks of heritable genetic effects are now considered to be much less than previously estimated and that improvements in technology since the 1950’s have resulted in up to a 95 % reduction in the absorbed dose to pelvic organs from radiography.

 

It also notes that gonadal shielding can interfere with the use of automatic exposure control, thereby causing an increase in dose to other pelvic and abdominal organs that may be more radiosensitive. It also may not completely shield the gonads in the majority of patients due to the limited area of the shield and the normal variations in patient anatomy. Moreover, a substantial portion of gonadal dose to the ovaries is delivered by scattered x rays that are not attenuated by gonadal shielding.

 

Gonadal shielding also obscures portions of pelvic anatomy and may obscure important findings on radiographs, limiting the practical dimensions and area of the shield.

 

Thus, NCRP concludes that in most circumstances gonadal shielding use does not contribute significantly to reducing risks from exposure and may have the unintended consequences of increased exposure and loss of valuable diagnostic information. Therefore, use of gonadal shielding is not justified as a routine part of radiological protection.

 

NCRP notes that gonadal shielding may be used for circumstances where a patient, parent or caregiver requests that gonadal shielding be used. It recommends such requests for use of gonadal shielding should be discussed to facilitate informed and mutual decision making. Information should be provided that will help to answer the patient’s questions and understand the risks and benefits. Gonadal shielding may be permissible when it will not interfere with the purpose of the examination. If consent for the examination cannot be obtained without its use, gonadal shielding use should adhere to institutional or practice guidelines or policies that minimize or eliminate the negative impact on diagnostic potential.

 

Acknowledging that many will question this move away from such a time-honored practice, NCRP also issued a companion statement “Implementation Guidance for Ending Routine Gonadal Shielding During Abdominal and Pelvic Radiography”.

 

 

References:

 

 

ACR (American College of Radiology). NCRP Recommends Against Routine Gonadal Shielding. American College of Radiology 2021; January 13, 2021

https://www.acr.org/Media-Center/ACR-News-Releases/2021/NCRP-Recommends-Against-Routine-Gonadal-Shielding

 

 

NCRP (National Council on Radiation Protection and Measurement). NCRP Recommendations for Ending Routine Gonadal Shielding During Abdominal and Pelvic Radiography. NCRP Statement No. 13, January 12, 2021

https://ncrponline.org/wp-content/themes/ncrp/PDFs/Statement13.pdf

 

 

NCRP (National Council on Radiation Protection and Measurement). Implementation Guidance for Ending Routine Gonadal Shielding During Abdominal and Pelvic Radiography. Companion to NCRP Statement No. 13, January 12, 202

https://ncrponline.org/wp-content/themes/ncrp/PDFs/Stat13_Companion_Comm.pdf

 

 

 

 

 

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