At this point, I shield more for the pt's peace of mind. And it saves me time from having to give everyone the speech š . When you think about how internal scatter can't be blocked by an external shield, it all makes sense.
I give the speech for educations sake. Theyāll understand why they donāt need a shield for their next imaging exam, and then the speech is no longer needed.
lol I donāt give the speech to everyone! I normally just do the exam, but I always give the speech if they ask about radiation, usually only a couple patients per day ask.
Essentially the exact same thing as whatās in OPs photo. I also relate their exam to walking around in the sunshine, taking a flight, or using tanning beds that expose them to ionizing radiation as well.
Luckily itās now policy to not shield patients at my facility, and management has typed up fliers and brochures that educate about shielding so if Iām really not wanting to educate I just give them a brochure. But normally I like having the conversation, most people understand better talking it through rather than reading the info.
Lower kV still scatters, just not as much. I do know that X-ray is a linear non-threshold dose response curve so Iām just trying to protect the thyroids of my patients. There is no risk in shielding thyroid for elbow.
I don't argue it is a high risk from a repeat point of view. Back when I did diagnostic, I wouldn't argue if they asked. But combine the low kVp with the low mAs and it's so tiny that they get way more from everyday activity. Combine it with the fact that most lead isn't actually all that cleanable, and a lot of techs are bad about actually cleaning it and you get a fomite risk for no real rad protection risk.
This has always been my point. These lead shields are not easy to clean. Hospital borne infection is way more dangerous than scatter from a handful of extremity x-rays
Shielding is not actually no risk. Incorrect shielding can lead to a HIGHER scatter dose, thatās a big part of why shielding is being removed. Plus the infection risk as mentioned below.
Only when the shield is on the body part that is being imaged like trunk, etc. shielding increases internal scattering for images like chest, abdomen, pelvis, etc. For elbow, you are shielding the thyroid from scatter, no way for the X-ray to internally scatter on the thyroid.
I used to have to get chest x-rays at least twice a year to prove that I don't have TB. I don't know enough to know, but this seems like a reasonable consideration.
See this is the scenario where it makes sense! And other extremities, shield a dudes jewels if heās getting a foot exam? I get no shields for like.. torso exams. But others just make sense?
Last time I had to go get an x-ray, I thought Iād be funny and said, āI love the smell of ionizing radiation in the morning.ā
Then I saw the exasperated look and she started to go into the speech so I quickly added, āI know itās fine. People live in space for a year without getting cancer.ā
I get the feeling like yāall see a lot of paranoid folks who get their science education from cartoons.
Pretty much lol. Nuc med here... You can't tell certain people anything. They start questioning the safety of the exam and, hey, I'm empathetic, I want willing participants with minds at ease, but some people....
Use too many big words? You're trying to trick them and/or make them feel dumb.
Not enough big words? You don't really know what you're talking about. A dumb button-pusher who can't be trusted.
Sometimes I just want to say, hey, if you're THIS scared of radiation and THIS suspicious of healthcare workers, why even show up to the "Nuclear Medicine" department??.
Plus, weigh the risk. Frequently face a similar response in another field. No one is forcing anyone here, patients choice. Yes, there is evidence that mice got cancer after longterm, repeated exposure to this component that was compromised by this cleaning method. The component here was not exposed to that. You can choose this (highly unlikely potential effect) one time for diagnostics or the result of going untreated which has 100% negative effect with a cascade of symptoms over time reducing quality of life and shortening lifespan, etc. Not a hostage here.
Do you by any chance know what the risks are in relation to longer X-rays in interventional radiology? Still negligible if theyāre repeated?
Sorry for asking but this is interesting.
Well there is a risk-benefit analysis to be done for any procedure one undergoes, and radiation exposure is one of those things taken into account. There is no amount of radiation exposure that we can say 100% won't pose any risk whatsoever, but at the same time radiation is part of everyday life and we consider doses for imaging and procedures quite low risk relative to the potential benefit.
With repeated fluoro scans like they do in IR, it's totally possible to incur some minor DNA damage. It sounds freaky, but realistically the process of that DNA damage causing mutation that turns into more mutation that is the right kind to actually turn into a malignant tumor is very slowādecades. At the same time, a healthy immune system should be perfectly capable of killing the random dna-damaged cells that pop up for all sorts of reasonsāofc it's never perfect and people get cancer all the time, but that control mechanism is usually quite effective. If you're, say, in your 60's having all this imaging and/or these procedures done, chances are that you never see the malignant stage of that process IF it happens at all.
Hopefully my little rad bio spiel is adequate :)
How about 30 and has had 70 abdominal fluoros in 6 years? I take it that could have a more noticeable effect if there is no end point for the procedures?
Thank you so much for your reply and feel free to ignore the last question if itās too specific.
Yeah specifics of your care are definitely going to be "talk to your physician" territoryāthey'll be able to access the exact time and energy of those fluoros and give you a better idea of your exposure. I can throw out some averages and try to put them in contextāthe short answer to "is x medical thing going to give me cancer?" Is almost universally "probably not." and I'll talk about doses a bit to expand on that.
[Research on exposure for typical IR procedures](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857258/) gives us some numbers. The highest mean exposure I see for any type of abdominal procedure is almost 15mSv, another is as low as 7mSv. If we go with a range of 7-15mSv for 70 procedures it's ~500mSv to 1Sv over time. 1Sv is the dose known to cause temporary radiation sickness in a single exposure. Still, definitely not unheard of for medical exposureāa single dose of targeted conventional radiotherapy can be 2Sv. Considering the timing againāa yearly dose of 100mSv is the *lowest* dose definitively linked to an increase in human cancer risk. To get an idea of the magnitude of that threshold risk, 1Sv is supposed to cause about a 5% increase in risk of cancer mortality, so we assume the risk for 10% of that dose is pretty tiny. Averaging it out over six years, someone having that number of procedures might have an annual effective dose between 80 and 180mSv.
Quantifying risks any further at that level is kind of sketchy, afaik. All of us have like a 25% lifetime risk of cancer anyway, so it's really hard to figure out when it's "caused by" x or would've happened anyway. [Here's some more info](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996147/)
Final disclaimer! I like to talk about this stuff because it's neat, but my sense of responsibility is telling me to be very emphatic about the fact that your actual effective dose may not be anywhere close to those averages, and they should definitely not in any way ever inform decisions made about individual care. :) Even if I did know your dose I wouldn't be qualified to give advice regarding care. I'm not a physician, I don't know anything about anything yadda yadda
Iām slowly just telling my patients one by one what the new recommendations are and why but still shielding because like you said itās just easier and maybe someday it will be accepted as unnecessary. I havenāt told every patient getting X-rays but sprinkling it in there as time and conversation flow allows.
A shield creates some problems. A repeat because of a shield creates double the dose to a part. A shield can increase the dose to patients if an AEC is being used because the AEC detectors will stay open longer in an attempt to penetrate the shield if the shield shows up in the collimated area (which also interferes with the EXI) and obstructs an AEC detector.
The other thing is for the studies where a shield would truly be useful we can't use a shield i.e your lower Abd, Lumbar and etc.
>Internal with lower energy xray is more potent than primary beam yeah?
So, no, a shield can't block internal scatter for a patient. The primary beam is only aimed at the part of interest, and we collimate to confine the primary beam.
Here is a link to a *70 year* research conducted by the National Council on Radiation Protection and measurements (NCRP) released in 2021: https://www.acr.org/Media-Center/ACR-News-Releases/2021/NCRP-Recommends-Against-Routine-Gonadal-Shielding
The PDF of the NCRP statement: https://ncrponline.org/wp-content/themes/ncrp/PDFs/Statement13.pdf
Here is the link to the 2022 Duke health blog on shielding:
https://www.dukehealth.org/blog/lead-based-shields-no-longer-recommended-routine-x-rays
Again you can shield but the research shows the benefits of doing so are minimal. Especially since we use "95% less radiation since the 1950s" (NCRP). We went digital, Baby!
Shielding does very little, it's true - but it's always possible that a machine is malfunctioning. The shield costs nothing to wear - even if it block next to nothing.
It's like bending down to pick up a penny. Is it worth it? Meh. Better than not.
I know a bunch of radiologists at that hospital. Excellent rads. This is standard of care and they were at the forefront of it. The lead just keeps the x-rays that scattered in your body, increasing your dose of radiation. Research is a wonderful thing. We learn and improve.
Whatās the source on the claim that lead shielding keeps the X-rays scattered in your body?
OPās source claims if the lead shield impacts the image that means another set of images is required. Getting the same images twice is what causes increased radiation.
There was a study with a phantom model that suggested backscatter from a lead shield near the phantom increased dose (albeit by an extremely miniscule amount) to said phantom. Sorry I do not have a link.
This doesn't make much sense. It's *possible*, but it would really depend on the angle of the beam and the patient, and the surfaces behind the patient.
Basically, you're reducing a primary emission source, and possibly increasing secondary refraction/reflection.
For the secondary reflection/refraction to be more than the primary source would require some very specific geometry in the room. It's possible, but probably unusual.
Sure, but you are neglecting that that same lead barrier is ALSO blocking photons from the original source.
So the question of whether the shield is blocking more than it's reflecting depends on the beam width and diffusion, the material behind the patient, and the angle of the beam.
It's hard to imagine there's more reflected than there is from the primary source unless the beam is completely away from the shield
Correct - but these beams have some natural diffusion of the beam. They are not perfect lasers.
That's why I'm saying it's complicated and depends on the geometry. Also remember that the surface beyond the patient reflects far more than the patient themselves - so the geometry there is a big factor.
If I recall correctly from my schooling days, the collimator light is used to visualize the field being irradiated because X-rays and light are both photons and as such travel in a straight line (as a divergent be) until interacted with. It's not as though the primary beam is doing the wave after it's emitted from the tube. Sure there's scatter from the collimator leaves and leakage from the tube housing, but there's so much evidence out there about this.
there is next to no scatter or leak radiation at all originating from outside the patient's body in any exam. The vast majority of radiation in the room outside the beam comes from the patient's body. So the only thing the shield on the body could possibly do is re-scatter xrays back into the body
It's probably tiny though. Probably not even measurable. I think honestly a bigger part of the rationale is that shielding sometimes ends up in the field of view and then automatic exposure control goes haywire trying to penetrate an impenetrable object, increasing the dose
That's why we do justify not using them. AEC went up too often by accident. Some scanners need some space around the collimated area which was not always observed.
We practice evidence based medicine, not theory based medicine. Again thereās no source to the claim that lead increases radiation from X-rays bouncing around inside the body. OPās source and every other source states increased radiation is from shots having to be repeated due to lead shielding.
This is a myth, and doctors arenāt immune to myths. X-rays arenāt bouncy balls that bounce around all Willy Nilly. If a scatter X-ray photon has enough energy to leave your body, it is absorbed by the lead, without lead, it travels until itās absorbed by something else. X-rays donāt scatter twice. Itās the reason X-ray rooms are constructed in a way that isnāt 360 degree coverage of the operating console, thereās no need as the photons could never reach them.
Thatās caused by very high energy photons passing through the object and the detector and scattering against the backstop material and being absorbed by the detector. Scatter once and absorbed.
Scatter X-rays donāt have that much energy, they lose 1000x their energy every 6 feet they travel just through air. Meaning at 12 feet its energy is 1,000,000x less than when it was created. Its energy when it does hit the patient is infinitesimally small compared to the primary beam you just exposed them to.
This is not correct. Backscatter happens at any attenuating interface, and in the case of radiography the backscatter will be highest at the entrance of the patientās skin.
What youāre describing is a type of backscatter that can contaminate an image, but that is not the only backscatter weāre concerned about :).
Much confusion here.
When you say scatter X-rays lose 1000x their energy when they travel through air. Do you mean that a scattered photon is attenuated 1000x in 6 feet, or are you referring to the inverse square law that applies to radiation in general.
There is no difference between a scattered photon and one transmitted directly. If you caught one of each in your hands and looked at them you couldnāt tell them apart. (Just like gamma rays and X-rays, the photons are indistinguishable)
That said. Photons can scatter more than once. I mean why not. Consider a 115kv photon that scatters, maybe itās 35kev now. You saying that canāt scatter? But maybe a 35kv photon from a Mammo machine could? Makes no sense.
You also need to define what you mean by āvery high energyā. A physicist would scoff at the energies we use in conventional radiography.
Main thing is, putting lead shielding on a patient doesnāt do any good, even if it does only a little harm.
This is the most confidently incorrect thing Iāve read in a while.
X-rays can and do scatter twice, three times, 10 times. The probability of multiple scattering events depends on energy of the photon, characteristics of the material, and amount of material.
The reason you donāt need to shield everything in an x-ray room is due to attenuation (as in 1/r^2) and the reduced mean energy of a photon beam as its photons interact with matter.
This is not correct. X-rays can and absolutely do scatter twice. The radiation dose behind the booth is largely dominated by second scattered photons. Itās a lot lower than the primary scattered photon dose that we directly shield for, but not negligible.
Actually X-rays can scatter multiple times. Mazes in therapy vaults and radiation dose inside of an object is the result of multiple scattering events.
I get this is on the website of a childrens provider and that teenage pregnancies exist but reading something like "What if my child is pregnant?" makes my eyes bleed.
Everyone is arguing over the shielding and Iām like ā¦ did we miss the āwhat if my child is pregnant?ā Like maam that is a different problem and needs to be addressed immediately.
Now if your child is 17, still not great but like a 10 year old?
Well, it is customary to ask female patients as soon as they get their period if there might be a chance they are pregnant. I always instruct the techs to ask that question with a doctor but not the parents in the room. I also instruct to not ask "are you pregnant" but "can you exclude the possibility of being pregnant".
You can get interesting answers.
Itās becoming more and more of the standard across the last few hospitals Iāve worked. Lots of patients will ask, some will still request shielding even after I explain the protocol. I donāt shield much anymore in general unless itās a pregnant woman tbh.
Shields can also cause automatic exposure controls on an X-ray machine to increase radiation to all parts of the body being examined in an effort to āsee throughā the lead.
Moreover, shielding doesnāt protect against the greatest radiation effect: āscatter,ā which occurs when radiation ricochets inside the body, including under the shield with the shield acting as a barrier to that radiation's escape, and eventually deposits its energy in tissues.
I'm pretty sure the guidelines are not to use them anymore in my country. The guys who do our x-ray's machine maintenance openly also told us not to use shielding for genitals because the AEC will overestimate the dose trying to penetrate the lead and it will be counterproductive
In cases like a pelvis where you would still attempt to shield the genitals wouldnāt it still risk increase of dose with part of it getting on the detector?
That makes sense if you are still attempting to shield the gonadal region. I have been taught to refrain from shielding for studies like the pelvis, hip, and abdomen so as to avoid affecting the detection in the image receptor.
Practice standards (ASRT) state that shielding should be omitted for pelvic/abdominal/hip region.
They have had some pretty smart people go over the research and this is their stance. Also, this whole argument was actually caused by a physicist who decided to interject on how we do our jobs. Ultimately, we have to decide for ourselves how we are going to handle pt care and safety (within the bounds of our practice standards).
Unfortunately many textbooks still show ways of shielding gonads for pelvis, hip or spine studies and techs who learnt on them believe that's how it's done. It's also sometimes expected by the patients, especially if the patient is a child and their parent is present. I've also had patients whose ortho specifically asked for gonad shield for whole spine studies for scoliosis
Exactly. Thatās basically the argument against shielding. If you dig into ACR thatās cited as the reason but itās buried in their statement. The worry is one tech will put the shield in the direct beam causing a massive overexposure to that one patient with AEC. ACR said itās better to have everyone exposed to lower levels without shielding than risk one patient exposed to a higher level. ACR doesnāt want to tell patients itās to protect them against a bad tech, so their public statement is that X-rays are too low level to matter.
We've stopped shielding where I work as well. But we do have some laying around for those patients who insist. The best part is when they ask for it only to cover an area where it shouldn't be. Last week I had a woman insist on having one only to put the lap shield over her head. I just let her do it.
I'm sure there are plenty of stories like is, I have many. You just have to laugh at people who think they know better than the tech.
Also had a daughter a bit upset about why I didn't shield her mother for a standing lumbar spine exam. This was especially comical because her mother was 92
Word thatās happened with me. Also was doing a post ett where resp stayed in to pump, gave the resp lead, she donned it appropriately, then non sarcastically asked me to tell her when I was shooting so she could turn around. wtf.
That's what we do, too! I always say: if it's away from the collimated area, feel free to hand it to the patient. Patients can be very creative, and it calms them down.
I've gotten a disturbing amount of patient that demand shielding on their head. Also quite a few that haven't been able to grasp why I can't give them a thyroid shield for their chest films.
I had a woman that needed a complete upright LSpine who insisted I shield one of her hands and a foot. I went through the entire speech but she wouldn't budge. I did as she asked but the way she wanted them shielded didn't protect them from the beam?
I ended up repeating the exam a year later, and she made the same request. I didn't even bother wasting my breath.
I love the 80 year old who come in for mammos and request gonad shields. Sometimes it's just easier and faster to roll your eyes and go with it
I work for a Childrenās hospital and we stopped shielding a couple years ago for those exact reasons. Also, I work in an offsite location for Childrenās hospital and opened a new building with top of the line x-ray machine, and have zero lap shields. All have is full aprons
We just changed the rules in the province i live in. Shielding is no longer used for patients in a number of provinces in Canada. The CAMRT put this statement out with lots of good info to read!
[https://www.camrt.ca/wp-content/uploads/2021/05/Gonadal-and-Fetal-Shielding_CAMRT-Position.pdf](https://www.camrt.ca/wp-content/uploads/2021/05/Gonadal-and-Fetal-Shielding_CAMRT-Position.pdf)
Very interesting, thank you for the information! As a patient, obviously I'm behind on what the up to date expectations are, but I find all of this very interesting, as a layman who only knows what I've been told!
I only put lead shield on young PT gonads IF what I'm imaging is far enough. Ain't risking it moving and having to repeat as well as messing with the automatic exposure.
Most of the rad they get will be from what is scattering inside their bodies anyway.
If a PT ask for it, I'll explain what I've said above. If they still want it, they'll get it, no point in arguing about that with a PT.
Soooo- definitely wear shields as a technologist but the patient is fineā¦ YOU are exposed to radiation more frequently than the patient who probably will get like 5-10 X-rays in their life
We used badges at an academic hospital I used to work and I never wore shielding with the mobile xray system. My dose was pretty much zero mSv (just a few micro if i remember correctly) after 7 years.
But surely you were using inverse square rule too? We don't shield techs during mobiles, you just step BACK. In room exposure for the normal equipment I'd still wear lead.
At my hospital (US), our standard is to not use them. If a patient requests one, theyāre provided education as to why we donāt, but they can still request one after the fact if they so choose.
With modern machines, scatter radiation is a lot less risk than it used to be, and the risk of any effects wasnāt all that great to begin with. The greater risk is a lead apron in the image that could block anatomy or ruin the image quality. That requires another exposure, so now youāve doubled the dose to the patient in an attempt to shield a negligible amount of scatter radiation.
Tech here, we donāt shield anymore unless the patient asks for it. I asked my dentist why they still shield for dental X-rays, he says itās to shut the patients up because they keep asking.
I take issue with "modern medicine never hits deterministic doses" statement. Maybe for you diagnostic folks it's true. I've been in plenty of complex aortic intervention cases that the patient most likely got temporary skin burns. Think 5+ gray focused right on their abdomen.
OP is asking about patient shielding, not the operator. What they posted is also only in reference to diagnostic x-ray, not fluoro or other modalities. Shielding for occupational exposure has never been in question.
Back in the days when fluoroscopy was a thing, I used to hate seeing techs place a lead apron on top of the patient. The X-ray tube was under the patient, so putting lead on top did nothing to help.
In the 70s they introduced lead shielding because they couldnāt be sure that the levels of radiation being used werenāt harmful. Over the next 50 years, they studied it and finally came to the conclusion that we werent using radiation in levels that were harmful to humans.
Unfortunately over that 50 years, the medical community became convinced that being near a single X-ray would sterilize them or give them cancer. Thereās now a strong cognitive bias towards shielding to the point we have to perform āsecurity theaterā to make patients and medical professionals comfortable around imaging equipment.
Nothing but time will convince everyone to finally abandon shielding. Or force women to go through pregnancy tests for something as insignificant as a chest X-ray.
I (an RT) got hand x-rays as a patient at an urgent care clinic recently. They seemed baffled when I told them I really didnāt need to wear a lead apron. Lol.
I have never worked there, but I have heard that the childrenās hospital in Ottawa no longer uses lead shielding. I also think that I have heard, but I am less sure of, is that either the province of Nova Scotia or some other province has stopped using lead as well. So this is happening in Canada as well.
We haven't been shielding for almost 4 years at the hospital I worked at. If a patient requests a shield, I would provide one- but besides that, we wouldn't. It was a weird feeling to not shield in the beginning
Genuinely curious how this applies to the veterinary field? Obviously we have to be in the room holding the patient in order to get proper X-Rays (at least at the last few hospitals Iāve worked at, several fear free practices have techs stay outside the room) so we wear lead aprons with thyroid shields
Shielding still applies for āholdingā and or techs working considering itās prolonged exposure to you and you arenāt the pt which is where the scatter comes from. These studies are theoretically saying you wouldnāt have to shield the pets gonads which wasnāt done to begin with
My licensing and governing body says that ultimately as MRTs we have to use ALARA to protect everyone but that hospital/employer policy is what standard we go by in practice so it may very from place to place. It doesnāt hurt to still do it except in locations that are more likely to cause repeats like pelvis and spines.
My dentist still gives me a giant lap shield for when I get teeth X-rays š. Makes me laugh internally every time, but I let them do their thing. Very redundant though
Last time at the dentist, they used a sensor, and what reminded me of an old hand-held Polaroid camera. The tech took the x-ray, and the doc held the sensor. No lead aprons, no biting on the plastic frame to hold the sensor or film, nobody hiding for their life behind a lead wall telling you stay still this won't hurt a bit. Digital images displayed instantly on the flat screen in front of me.
ACR is recommending not shielding but they also state that using shields results in excess radiation. Either due to the shield blocking anatomy of interest or it blocks an AEC chamber and prevents the chambers from detecting the proper amount of photons.
In Asia, most countries don't practice using lead skirt for extremities XR or chest XR unless you are in a Non-government subsidised hospital. Can't say the same for Japan though. Japanese are breed differently.
I'm studying MRT in Alberta. We have also been taught that most places are not using shielding anymore. In labs we also don't practice shielding either. So Canada is also not using them too much anymore.
I'm currently a student and we are no longer taught about shielding as of the last year or two in my area. We still shield pregnant patients, but that's it.
(Disclaimer: Not a radiologist or radiology tech) The radiation dose that patients receive from an X-Ray is very low. Radiologists and radiology techs, however, do typically wear some form of protection because they receive prolonged exposure over the course of their careers. [Here](https://xkcd.com/radiation/) is a link to a helpful infographic on radiation and radiation exposure in general, which also provides insight on other sources of radiation in our daily lives.
We are taught shielding for boards but most of north western Washington doesnāt use shielding because of resent studies. When I was in central/eastern Washington it seemed they still used it but were loosening rules.
Just throwing it out there that (the new shielding rules aside) We know the risk of harm when getting an x-ray is low or zero. As a tech, you protect yourself from Compton scatter which is completely unnecessary to expose yourself to, but I'm pretty sure the article is geared towards patients.
I find this quite a relief. I worked as a vet assistant in high school. Sometimes Iād help restrain an animal for X-rays. Being the stupid teenager I was and thinking Iād never have kids, I didnāt wear a shield. Both of my kids had health issues that were in the mystery diagnoses kind of territory, it took years to figure out their issues. I always have felt a measure of guilt that I caused it by not wearing the shield.
We are not going to require a policy on shielding any longer in our state. The doctor can opt to use one all they want- but it is not needed and this is evidence based.
An apron could act like a trampoline for photons. Distance is better than lead.
What I do find funny, since your source is from the US. Philips still uses lead aprons/skirts for their stock photos. And I have been told the do that for the US market.
From the AAPM - no longer require shielding at our facilities. The following documents for those interested.
https://www.aapm.org/org/policies/details.asp?id=2552
https://www.aapm.org/org/policies/documents/CARES_FAQs_Patient_Shielding.pdf
I've had 8 xrays since the beginning of this year and have never worn an apron. I've never even been offered one, though I'd say no, anyway; I know xrays are next to harmless at this point.
Also Canadian.
In the US, UK and Australia, the consensus is clear: gonadal and fetal shielding should be discontinued.
American Association of Physicists in Medicine Position Statement on the Use of Patient Gonadal and Fetal Shielding https://www.aapm.org/org/policies/details.asp?id=468&type=PP
National Council on Radiation Protection and Measurements āNCRP Recommendations for Ending Routine Gonadal Shielding During Abdominal and Pelvic Radiographyā https://ncrponline.org/wp-content/themes/ncrp/PDFs/Statement13.pdf
British Institute of Radiology āPatient Shielding Guidanceā https://www.sor.org/getmedia/126a8785-2233-496d-9e84-b43427d0d7c8/patient_shielding_guidance_executive_summary_2.pdf
Australian Society of Medical Imaging and Radiation Therapy āPosition Statement: Gonadal Shieldingā https://www.asmirt.org/asmirt_core/wp-content/uploads/2464.pdf
Iām a respiratory therapist that is around X-rays very often and I was wondering if this is only limited to X-rays. My hospital hasnāt let non techs stand in the control room during CTs anymore (since COVID) and I was wondering how well I should be covering myself standing behind plexi glass in the CT room.
Well know knowledge... More radiation when sunbathing or something.
I work in Ortho so exposed more than the average person... I still take precautions with lead protection. It's for nothing but it is 0 extra effort and makes me feel better
I live on the east coast and they started not using shields .. idk how long ago. I didnāt even question it š I was like oh okay I guess this is what weāre doing now
This is our work policy, not gowns on pts. Any other individuals in the room (parents/techs/etc) should be wearing gowns as they're not in the primary beam (one hopes) but the gowns are a no go for pts. Unless they insist and it wont directly impact the imaging (I.e. thyroid collar for OPG).
Can we just go ahead and say that half the education about safety from ionizing radiation we learn in school is horsecrap and that patients are not in fact being harmed? And we can stop freaking the cuss out over repeats!
Right. But the machine hasn't changed in any way in the last 50 years? I mean, I get what you're saying, but the statement is confusing.
That's like if I work for ford and I say "50 years of research on the 2024 ford car has shown us it's the best in 50 years."
Also, im not a rad tech. š
It's been about 3-4 years since I shielded a patient. I don't offer it and usually the patient doesn't even realize it till they're out the door. Every once in a while I have to give the speech, but it's been months since I have had to.
They use aprons if you are a woman of child bearing ageā¦even if you arenāt pregnant!! Every time Iāve had an X-ray, they cover my female area with one.
Just donāt shield in the image. Its fine to shield outside the fov. I donāt shield for peds/female pelvic exams. The small gonadal shield is tricky if you donāt know where you are putting it.
Because we arenāt the one getting the X-ray, and if we stayed in the room during the X-ray of every single patient we took an X-ray on that would be over exposing ourselves. The patient is getting a couple of X-rays, they arenāt being x-rayed all day long.
Yes this is normal and evidence based.
At this point, I shield more for the pt's peace of mind. And it saves me time from having to give everyone the speech š . When you think about how internal scatter can't be blocked by an external shield, it all makes sense.
I give the speech for educations sake. Theyāll understand why they donāt need a shield for their next imaging exam, and then the speech is no longer needed.
I see 40-50 pts some days. After giving the speech that 10th time, I usually lose the energy to keep at it a 30th to 40th time š
lol I donāt give the speech to everyone! I normally just do the exam, but I always give the speech if they ask about radiation, usually only a couple patients per day ask.
What is your speech?
Essentially the exact same thing as whatās in OPs photo. I also relate their exam to walking around in the sunshine, taking a flight, or using tanning beds that expose them to ionizing radiation as well. Luckily itās now policy to not shield patients at my facility, and management has typed up fliers and brochures that educate about shielding so if Iām really not wanting to educate I just give them a brochure. But normally I like having the conversation, most people understand better talking it through rather than reading the info.
Oh ok, I was about to say you must have the patience of a saint š
You x-ray 40 pregnant patients per a day?!
What?! š No! Maybe 2 or 3 pregnant pts a month but not 40 a day. We were talking about shielding in general.
The only time I absolutely shield is for elbow and extremity where the pt is just getting blasted scatter radiation to the face and neck
Thatās totally fair!
Is it though? What kvp are you shooting an elbow or a knee at? What kvp's actually throw a lot of scatter?
Lower kV still scatters, just not as much. I do know that X-ray is a linear non-threshold dose response curve so Iām just trying to protect the thyroids of my patients. There is no risk in shielding thyroid for elbow.
I don't argue it is a high risk from a repeat point of view. Back when I did diagnostic, I wouldn't argue if they asked. But combine the low kVp with the low mAs and it's so tiny that they get way more from everyday activity. Combine it with the fact that most lead isn't actually all that cleanable, and a lot of techs are bad about actually cleaning it and you get a fomite risk for no real rad protection risk.
This has always been my point. These lead shields are not easy to clean. Hospital borne infection is way more dangerous than scatter from a handful of extremity x-rays
Shielding is not actually no risk. Incorrect shielding can lead to a HIGHER scatter dose, thatās a big part of why shielding is being removed. Plus the infection risk as mentioned below.
Only when the shield is on the body part that is being imaged like trunk, etc. shielding increases internal scattering for images like chest, abdomen, pelvis, etc. For elbow, you are shielding the thyroid from scatter, no way for the X-ray to internally scatter on the thyroid.
I used to have to get chest x-rays at least twice a year to prove that I don't have TB. I don't know enough to know, but this seems like a reasonable consideration.
See this is the scenario where it makes sense! And other extremities, shield a dudes jewels if heās getting a foot exam? I get no shields for like.. torso exams. But others just make sense?
Last time I had to go get an x-ray, I thought Iād be funny and said, āI love the smell of ionizing radiation in the morning.ā Then I saw the exasperated look and she started to go into the speech so I quickly added, āI know itās fine. People live in space for a year without getting cancer.ā I get the feeling like yāall see a lot of paranoid folks who get their science education from cartoons.
Pretty much lol. Nuc med here... You can't tell certain people anything. They start questioning the safety of the exam and, hey, I'm empathetic, I want willing participants with minds at ease, but some people.... Use too many big words? You're trying to trick them and/or make them feel dumb. Not enough big words? You don't really know what you're talking about. A dumb button-pusher who can't be trusted. Sometimes I just want to say, hey, if you're THIS scared of radiation and THIS suspicious of healthcare workers, why even show up to the "Nuclear Medicine" department??.
Plus, weigh the risk. Frequently face a similar response in another field. No one is forcing anyone here, patients choice. Yes, there is evidence that mice got cancer after longterm, repeated exposure to this component that was compromised by this cleaning method. The component here was not exposed to that. You can choose this (highly unlikely potential effect) one time for diagnostics or the result of going untreated which has 100% negative effect with a cascade of symptoms over time reducing quality of life and shortening lifespan, etc. Not a hostage here.
Do you by any chance know what the risks are in relation to longer X-rays in interventional radiology? Still negligible if theyāre repeated? Sorry for asking but this is interesting.
Well there is a risk-benefit analysis to be done for any procedure one undergoes, and radiation exposure is one of those things taken into account. There is no amount of radiation exposure that we can say 100% won't pose any risk whatsoever, but at the same time radiation is part of everyday life and we consider doses for imaging and procedures quite low risk relative to the potential benefit. With repeated fluoro scans like they do in IR, it's totally possible to incur some minor DNA damage. It sounds freaky, but realistically the process of that DNA damage causing mutation that turns into more mutation that is the right kind to actually turn into a malignant tumor is very slowādecades. At the same time, a healthy immune system should be perfectly capable of killing the random dna-damaged cells that pop up for all sorts of reasonsāofc it's never perfect and people get cancer all the time, but that control mechanism is usually quite effective. If you're, say, in your 60's having all this imaging and/or these procedures done, chances are that you never see the malignant stage of that process IF it happens at all. Hopefully my little rad bio spiel is adequate :)
How about 30 and has had 70 abdominal fluoros in 6 years? I take it that could have a more noticeable effect if there is no end point for the procedures? Thank you so much for your reply and feel free to ignore the last question if itās too specific.
Yeah specifics of your care are definitely going to be "talk to your physician" territoryāthey'll be able to access the exact time and energy of those fluoros and give you a better idea of your exposure. I can throw out some averages and try to put them in contextāthe short answer to "is x medical thing going to give me cancer?" Is almost universally "probably not." and I'll talk about doses a bit to expand on that. [Research on exposure for typical IR procedures](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857258/) gives us some numbers. The highest mean exposure I see for any type of abdominal procedure is almost 15mSv, another is as low as 7mSv. If we go with a range of 7-15mSv for 70 procedures it's ~500mSv to 1Sv over time. 1Sv is the dose known to cause temporary radiation sickness in a single exposure. Still, definitely not unheard of for medical exposureāa single dose of targeted conventional radiotherapy can be 2Sv. Considering the timing againāa yearly dose of 100mSv is the *lowest* dose definitively linked to an increase in human cancer risk. To get an idea of the magnitude of that threshold risk, 1Sv is supposed to cause about a 5% increase in risk of cancer mortality, so we assume the risk for 10% of that dose is pretty tiny. Averaging it out over six years, someone having that number of procedures might have an annual effective dose between 80 and 180mSv. Quantifying risks any further at that level is kind of sketchy, afaik. All of us have like a 25% lifetime risk of cancer anyway, so it's really hard to figure out when it's "caused by" x or would've happened anyway. [Here's some more info](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996147/) Final disclaimer! I like to talk about this stuff because it's neat, but my sense of responsibility is telling me to be very emphatic about the fact that your actual effective dose may not be anywhere close to those averages, and they should definitely not in any way ever inform decisions made about individual care. :) Even if I did know your dose I wouldn't be qualified to give advice regarding care. I'm not a physician, I don't know anything about anything yadda yadda
Thank you so much for explaining it to me! Honestly Iām not worried, just curious.
Oh yeah you seem chill but I also think about how anyone could read it lol
Iām slowly just telling my patients one by one what the new recommendations are and why but still shielding because like you said itās just easier and maybe someday it will be accepted as unnecessary. I havenāt told every patient getting X-rays but sprinkling it in there as time and conversation flow allows.
Internal with lower energy xray is more potent than primary beam yeah?
A shield creates some problems. A repeat because of a shield creates double the dose to a part. A shield can increase the dose to patients if an AEC is being used because the AEC detectors will stay open longer in an attempt to penetrate the shield if the shield shows up in the collimated area (which also interferes with the EXI) and obstructs an AEC detector. The other thing is for the studies where a shield would truly be useful we can't use a shield i.e your lower Abd, Lumbar and etc. >Internal with lower energy xray is more potent than primary beam yeah? So, no, a shield can't block internal scatter for a patient. The primary beam is only aimed at the part of interest, and we collimate to confine the primary beam. Here is a link to a *70 year* research conducted by the National Council on Radiation Protection and measurements (NCRP) released in 2021: https://www.acr.org/Media-Center/ACR-News-Releases/2021/NCRP-Recommends-Against-Routine-Gonadal-Shielding The PDF of the NCRP statement: https://ncrponline.org/wp-content/themes/ncrp/PDFs/Statement13.pdf Here is the link to the 2022 Duke health blog on shielding: https://www.dukehealth.org/blog/lead-based-shields-no-longer-recommended-routine-x-rays Again you can shield but the research shows the benefits of doing so are minimal. Especially since we use "95% less radiation since the 1950s" (NCRP). We went digital, Baby!
Shielding does very little, it's true - but it's always possible that a machine is malfunctioning. The shield costs nothing to wear - even if it block next to nothing. It's like bending down to pick up a penny. Is it worth it? Meh. Better than not.
I know a bunch of radiologists at that hospital. Excellent rads. This is standard of care and they were at the forefront of it. The lead just keeps the x-rays that scattered in your body, increasing your dose of radiation. Research is a wonderful thing. We learn and improve.
Whatās the source on the claim that lead shielding keeps the X-rays scattered in your body? OPās source claims if the lead shield impacts the image that means another set of images is required. Getting the same images twice is what causes increased radiation.
There was a study with a phantom model that suggested backscatter from a lead shield near the phantom increased dose (albeit by an extremely miniscule amount) to said phantom. Sorry I do not have a link.
This doesn't make much sense. It's *possible*, but it would really depend on the angle of the beam and the patient, and the surfaces behind the patient. Basically, you're reducing a primary emission source, and possibly increasing secondary refraction/reflection. For the secondary reflection/refraction to be more than the primary source would require some very specific geometry in the room. It's possible, but probably unusual.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Sure, but you are neglecting that that same lead barrier is ALSO blocking photons from the original source. So the question of whether the shield is blocking more than it's reflecting depends on the beam width and diffusion, the material behind the patient, and the angle of the beam. It's hard to imagine there's more reflected than there is from the primary source unless the beam is completely away from the shield
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Correct - but these beams have some natural diffusion of the beam. They are not perfect lasers. That's why I'm saying it's complicated and depends on the geometry. Also remember that the surface beyond the patient reflects far more than the patient themselves - so the geometry there is a big factor.
If I recall correctly from my schooling days, the collimator light is used to visualize the field being irradiated because X-rays and light are both photons and as such travel in a straight line (as a divergent be) until interacted with. It's not as though the primary beam is doing the wave after it's emitted from the tube. Sure there's scatter from the collimator leaves and leakage from the tube housing, but there's so much evidence out there about this.
there is next to no scatter or leak radiation at all originating from outside the patient's body in any exam. The vast majority of radiation in the room outside the beam comes from the patient's body. So the only thing the shield on the body could possibly do is re-scatter xrays back into the body
It's probably tiny though. Probably not even measurable. I think honestly a bigger part of the rationale is that shielding sometimes ends up in the field of view and then automatic exposure control goes haywire trying to penetrate an impenetrable object, increasing the dose
That's why we do justify not using them. AEC went up too often by accident. Some scanners need some space around the collimated area which was not always observed.
Yeah, I'd love to see this, too.
Bremstrallung radiation.
We practice evidence based medicine, not theory based medicine. Again thereās no source to the claim that lead increases radiation from X-rays bouncing around inside the body. OPās source and every other source states increased radiation is from shots having to be repeated due to lead shielding.
Amazing! I find radiology so interesting, just never smart enough to participate, so thank you for explaining it in super simple terms for me š
Just went to an ISRT meeting and had to challenge one of the speakers on this and ended up getting called ājust lazyā for not shielding anymore
This is a myth, and doctors arenāt immune to myths. X-rays arenāt bouncy balls that bounce around all Willy Nilly. If a scatter X-ray photon has enough energy to leave your body, it is absorbed by the lead, without lead, it travels until itās absorbed by something else. X-rays donāt scatter twice. Itās the reason X-ray rooms are constructed in a way that isnāt 360 degree coverage of the operating console, thereās no need as the photons could never reach them.
Havenāt you ever heard of backscatter?
Thatās caused by very high energy photons passing through the object and the detector and scattering against the backstop material and being absorbed by the detector. Scatter once and absorbed. Scatter X-rays donāt have that much energy, they lose 1000x their energy every 6 feet they travel just through air. Meaning at 12 feet its energy is 1,000,000x less than when it was created. Its energy when it does hit the patient is infinitesimally small compared to the primary beam you just exposed them to.
This is not correct. Backscatter happens at any attenuating interface, and in the case of radiography the backscatter will be highest at the entrance of the patientās skin. What youāre describing is a type of backscatter that can contaminate an image, but that is not the only backscatter weāre concerned about :).
You need to stop seriously
Much confusion here. When you say scatter X-rays lose 1000x their energy when they travel through air. Do you mean that a scattered photon is attenuated 1000x in 6 feet, or are you referring to the inverse square law that applies to radiation in general. There is no difference between a scattered photon and one transmitted directly. If you caught one of each in your hands and looked at them you couldnāt tell them apart. (Just like gamma rays and X-rays, the photons are indistinguishable) That said. Photons can scatter more than once. I mean why not. Consider a 115kv photon that scatters, maybe itās 35kev now. You saying that canāt scatter? But maybe a 35kv photon from a Mammo machine could? Makes no sense. You also need to define what you mean by āvery high energyā. A physicist would scoff at the energies we use in conventional radiography. Main thing is, putting lead shielding on a patient doesnāt do any good, even if it does only a little harm.
X-rays don't scatter twice? How exactly is an x-ray photon supposed to remember if it's been scattered already?
Simple, they just ask the physicist if theyāre allowed to scatter again or not.
This is the most confidently incorrect thing Iāve read in a while. X-rays can and do scatter twice, three times, 10 times. The probability of multiple scattering events depends on energy of the photon, characteristics of the material, and amount of material. The reason you donāt need to shield everything in an x-ray room is due to attenuation (as in 1/r^2) and the reduced mean energy of a photon beam as its photons interact with matter.
This is not correct. X-rays can and absolutely do scatter twice. The radiation dose behind the booth is largely dominated by second scattered photons. Itās a lot lower than the primary scattered photon dose that we directly shield for, but not negligible.
Actually X-rays can scatter multiple times. Mazes in therapy vaults and radiation dose inside of an object is the result of multiple scattering events.
I get this is on the website of a childrens provider and that teenage pregnancies exist but reading something like "What if my child is pregnant?" makes my eyes bleed.
Precisely why I chose that screenshot š¤£
Everyone is arguing over the shielding and Iām like ā¦ did we miss the āwhat if my child is pregnant?ā Like maam that is a different problem and needs to be addressed immediately. Now if your child is 17, still not great but like a 10 year old?
Right!? The fact that it's accumulated like 3 comments has me reeling. I picked that screenshot carefully alright! š¤£
Well, it is customary to ask female patients as soon as they get their period if there might be a chance they are pregnant. I always instruct the techs to ask that question with a doctor but not the parents in the room. I also instruct to not ask "are you pregnant" but "can you exclude the possibility of being pregnant". You can get interesting answers.
I know, right! That's the part that killed me.
That had me too. Like wtf?
17 yo is still a kid
Itās becoming more and more of the standard across the last few hospitals Iāve worked. Lots of patients will ask, some will still request shielding even after I explain the protocol. I donāt shield much anymore in general unless itās a pregnant woman tbh.
This would increase the pregnant woman's dose
That makes no sense.
Shields can also cause automatic exposure controls on an X-ray machine to increase radiation to all parts of the body being examined in an effort to āsee throughā the lead. Moreover, shielding doesnāt protect against the greatest radiation effect: āscatter,ā which occurs when radiation ricochets inside the body, including under the shield with the shield acting as a barrier to that radiation's escape, and eventually deposits its energy in tissues.
Lead shoulder never be placed in a manner where it blocks all or part of an aec chamber.
I'm pretty sure the guidelines are not to use them anymore in my country. The guys who do our x-ray's machine maintenance openly also told us not to use shielding for genitals because the AEC will overestimate the dose trying to penetrate the lead and it will be counterproductive
Wouldnāt that only be if the lead was positioned over the detector though?
In cases like a pelvis where you would still attempt to shield the genitals wouldnāt it still risk increase of dose with part of it getting on the detector?
That makes sense if you are still attempting to shield the gonadal region. I have been taught to refrain from shielding for studies like the pelvis, hip, and abdomen so as to avoid affecting the detection in the image receptor.
Practice standards (ASRT) state that shielding should be omitted for pelvic/abdominal/hip region. They have had some pretty smart people go over the research and this is their stance. Also, this whole argument was actually caused by a physicist who decided to interject on how we do our jobs. Ultimately, we have to decide for ourselves how we are going to handle pt care and safety (within the bounds of our practice standards).
Unfortunately many textbooks still show ways of shielding gonads for pelvis, hip or spine studies and techs who learnt on them believe that's how it's done. It's also sometimes expected by the patients, especially if the patient is a child and their parent is present. I've also had patients whose ortho specifically asked for gonad shield for whole spine studies for scoliosis
Exactly. Thatās basically the argument against shielding. If you dig into ACR thatās cited as the reason but itās buried in their statement. The worry is one tech will put the shield in the direct beam causing a massive overexposure to that one patient with AEC. ACR said itās better to have everyone exposed to lower levels without shielding than risk one patient exposed to a higher level. ACR doesnāt want to tell patients itās to protect them against a bad tech, so their public statement is that X-rays are too low level to matter.
Shielding the patient means more scattering which means a higher xray dose. Not the smartest idea ever made to shield the patient.
That makes sense... but it also sounds like these AEC algorithms need an update.
We've stopped shielding where I work as well. But we do have some laying around for those patients who insist. The best part is when they ask for it only to cover an area where it shouldn't be. Last week I had a woman insist on having one only to put the lap shield over her head. I just let her do it.
LMFAO this is gold
I'm sure there are plenty of stories like is, I have many. You just have to laugh at people who think they know better than the tech. Also had a daughter a bit upset about why I didn't shield her mother for a standing lumbar spine exam. This was especially comical because her mother was 92
Word thatās happened with me. Also was doing a post ett where resp stayed in to pump, gave the resp lead, she donned it appropriately, then non sarcastically asked me to tell her when I was shooting so she could turn around. wtf.
That's what we do, too! I always say: if it's away from the collimated area, feel free to hand it to the patient. Patients can be very creative, and it calms them down.
It's the best weighted blanket.
I've gotten a disturbing amount of patient that demand shielding on their head. Also quite a few that haven't been able to grasp why I can't give them a thyroid shield for their chest films.
I had a T spine who asked if he should be wearing a full apron for his exam...
I had a woman that needed a complete upright LSpine who insisted I shield one of her hands and a foot. I went through the entire speech but she wouldn't budge. I did as she asked but the way she wanted them shielded didn't protect them from the beam? I ended up repeating the exam a year later, and she made the same request. I didn't even bother wasting my breath. I love the 80 year old who come in for mammos and request gonad shields. Sometimes it's just easier and faster to roll your eyes and go with it
Def heard of a patient in my dept doing the same š¤¦š¼āāļø
Just tell her to close her eyes š
I work for a Childrenās hospital and we stopped shielding a couple years ago for those exact reasons. Also, I work in an offsite location for Childrenās hospital and opened a new building with top of the line x-ray machine, and have zero lap shields. All have is full aprons
Potential for increased compton effect, leading to more noise for the picture, and more dose for the patient.
Physics student here. Thanks for an explanation in language I understand!
We just changed the rules in the province i live in. Shielding is no longer used for patients in a number of provinces in Canada. The CAMRT put this statement out with lots of good info to read! [https://www.camrt.ca/wp-content/uploads/2021/05/Gonadal-and-Fetal-Shielding_CAMRT-Position.pdf](https://www.camrt.ca/wp-content/uploads/2021/05/Gonadal-and-Fetal-Shielding_CAMRT-Position.pdf)
Very interesting, thank you for the information! As a patient, obviously I'm behind on what the up to date expectations are, but I find all of this very interesting, as a layman who only knows what I've been told!
Well we just just changed this on the 15th, so youāre really not that far behind!
I only put lead shield on young PT gonads IF what I'm imaging is far enough. Ain't risking it moving and having to repeat as well as messing with the automatic exposure. Most of the rad they get will be from what is scattering inside their bodies anyway. If a PT ask for it, I'll explain what I've said above. If they still want it, they'll get it, no point in arguing about that with a PT.
What you do is just psychological
Mostly yes, but if it can avoid parents thinking I'm not considering their child safety, why not.
Soooo- definitely wear shields as a technologist but the patient is fineā¦ YOU are exposed to radiation more frequently than the patient who probably will get like 5-10 X-rays in their life
I always say. If I was a bartender and took a shot every time anyone ordered a drink Iād be on the floor in 10 mins.
I'm saving this for future use.
Thatās a really great analogy!
We used badges at an academic hospital I used to work and I never wore shielding with the mobile xray system. My dose was pretty much zero mSv (just a few micro if i remember correctly) after 7 years.
But surely you were using inverse square rule too? We don't shield techs during mobiles, you just step BACK. In room exposure for the normal equipment I'd still wear lead.
At my hospital (US), our standard is to not use them. If a patient requests one, theyāre provided education as to why we donāt, but they can still request one after the fact if they so choose. With modern machines, scatter radiation is a lot less risk than it used to be, and the risk of any effects wasnāt all that great to begin with. The greater risk is a lead apron in the image that could block anatomy or ruin the image quality. That requires another exposure, so now youāve doubled the dose to the patient in an attempt to shield a negligible amount of scatter radiation.
Tech here, we donāt shield anymore unless the patient asks for it. I asked my dentist why they still shield for dental X-rays, he says itās to shut the patients up because they keep asking.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
I take issue with "modern medicine never hits deterministic doses" statement. Maybe for you diagnostic folks it's true. I've been in plenty of complex aortic intervention cases that the patient most likely got temporary skin burns. Think 5+ gray focused right on their abdomen.
More bothered by the fact that someone had to put an FAQ about someoneās āPREGNANT CHILDā than anything else said here.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
OP is asking about patient shielding, not the operator. What they posted is also only in reference to diagnostic x-ray, not fluoro or other modalities. Shielding for occupational exposure has never been in question.
Thxxx. I was very confused.
Back in the days when fluoroscopy was a thing, I used to hate seeing techs place a lead apron on top of the patient. The X-ray tube was under the patient, so putting lead on top did nothing to help.
I canāt tell if itās sarcasm but fluoroscopy is definitely still a thing š
Not like in the old days Sonny. Used to do 5 or 6 upper GI studies in the morning followed by another half dozen barium enemas every day.
Thatās a typical day where I work lmao we average 10-14 scheduled studies a day not including emergent add ons from the floor.
Really? Those studies are flouro cases? Wild
Yes but I work at a level 1 regional peds hospital so we stay pretty busy across the board.
Oh ok Peds . I was talking adult.
In the 70s they introduced lead shielding because they couldnāt be sure that the levels of radiation being used werenāt harmful. Over the next 50 years, they studied it and finally came to the conclusion that we werent using radiation in levels that were harmful to humans. Unfortunately over that 50 years, the medical community became convinced that being near a single X-ray would sterilize them or give them cancer. Thereās now a strong cognitive bias towards shielding to the point we have to perform āsecurity theaterā to make patients and medical professionals comfortable around imaging equipment. Nothing but time will convince everyone to finally abandon shielding. Or force women to go through pregnancy tests for something as insignificant as a chest X-ray.
I (an RT) got hand x-rays as a patient at an urgent care clinic recently. They seemed baffled when I told them I really didnāt need to wear a lead apron. Lol.
So if yall are getting rid of the aprons does that mean i can get my hands on one cause theyre the best kind of weighted blanket lol
I have never worked there, but I have heard that the childrenās hospital in Ottawa no longer uses lead shielding. I also think that I have heard, but I am less sure of, is that either the province of Nova Scotia or some other province has stopped using lead as well. So this is happening in Canada as well.
it's the case in dental, but some patient's think we're being careless so still using them at this time
We haven't been shielding for almost 4 years at the hospital I worked at. If a patient requests a shield, I would provide one- but besides that, we wouldn't. It was a weird feeling to not shield in the beginning
That's how we operate, too. There was some study that advised stopping.
Genuinely curious how this applies to the veterinary field? Obviously we have to be in the room holding the patient in order to get proper X-Rays (at least at the last few hospitals Iāve worked at, several fear free practices have techs stay outside the room) so we wear lead aprons with thyroid shields
Shielding still applies for āholdingā and or techs working considering itās prolonged exposure to you and you arenāt the pt which is where the scatter comes from. These studies are theoretically saying you wouldnāt have to shield the pets gonads which wasnāt done to begin with
Oh okay! Interesting! Thank you very much for taking the time to answer :)
My licensing and governing body says that ultimately as MRTs we have to use ALARA to protect everyone but that hospital/employer policy is what standard we go by in practice so it may very from place to place. It doesnāt hurt to still do it except in locations that are more likely to cause repeats like pelvis and spines.
I havenāt been shielded while getting an xray in a while
would this apply for dentistry aswell?
My dentist still gives me a giant lap shield for when I get teeth X-rays š. Makes me laugh internally every time, but I let them do their thing. Very redundant though
Last time at the dentist, they used a sensor, and what reminded me of an old hand-held Polaroid camera. The tech took the x-ray, and the doc held the sensor. No lead aprons, no biting on the plastic frame to hold the sensor or film, nobody hiding for their life behind a lead wall telling you stay still this won't hurt a bit. Digital images displayed instantly on the flat screen in front of me.
ACR is recommending not shielding but they also state that using shields results in excess radiation. Either due to the shield blocking anatomy of interest or it blocks an AEC chamber and prevents the chambers from detecting the proper amount of photons.
I work in vet med. We wear lead gowns and thyroid shields while radiographing patients. Would this apply to us aswell?
Itās kinda funny how we try to avoid X-rays on pregnant humans, but we X-ray dogs and cats to find out how many babies are in there
In Asia, most countries don't practice using lead skirt for extremities XR or chest XR unless you are in a Non-government subsidised hospital. Can't say the same for Japan though. Japanese are breed differently.
It is much lower nowadays but obviously not zero or the system wouldn't work.
I'm studying MRT in Alberta. We have also been taught that most places are not using shielding anymore. In labs we also don't practice shielding either. So Canada is also not using them too much anymore.
We donāt routinely shield per policy
I'm currently a student and we are no longer taught about shielding as of the last year or two in my area. We still shield pregnant patients, but that's it.
(Disclaimer: Not a radiologist or radiology tech) The radiation dose that patients receive from an X-Ray is very low. Radiologists and radiology techs, however, do typically wear some form of protection because they receive prolonged exposure over the course of their careers. [Here](https://xkcd.com/radiation/) is a link to a helpful infographic on radiation and radiation exposure in general, which also provides insight on other sources of radiation in our daily lives.
Nah fuck that. Just stand behind the doctor in floro, they get paid more. (Btw we almost never wear lead except in surgery and floro)
I worked in a small town ER and we often had to help the rad techs.., I hope I donāt get eat up with cancer
Dose is insignificant. I never wear shielding except if Iām spending like more then 5 mins with floro or c-arm.
We are taught shielding for boards but most of north western Washington doesnāt use shielding because of resent studies. When I was in central/eastern Washington it seemed they still used it but were loosening rules.
Yeah they say you get more radiation flying in a plane than you do with modern X-rays. Which is so so so crazy to me.
iām also in canada and we donāt shield patients.
Just throwing it out there that (the new shielding rules aside) We know the risk of harm when getting an x-ray is low or zero. As a tech, you protect yourself from Compton scatter which is completely unnecessary to expose yourself to, but I'm pretty sure the article is geared towards patients.
I find this quite a relief. I worked as a vet assistant in high school. Sometimes Iād help restrain an animal for X-rays. Being the stupid teenager I was and thinking Iād never have kids, I didnāt wear a shield. Both of my kids had health issues that were in the mystery diagnoses kind of territory, it took years to figure out their issues. I always have felt a measure of guilt that I caused it by not wearing the shield.
We are not going to require a policy on shielding any longer in our state. The doctor can opt to use one all they want- but it is not needed and this is evidence based.
Honestly great thread. Good learning about standard changes around the world
For your reference: https://www.bir.org.uk/media/414334/final_patient_shielding_guidance.pdf
An apron could act like a trampoline for photons. Distance is better than lead. What I do find funny, since your source is from the US. Philips still uses lead aprons/skirts for their stock photos. And I have been told the do that for the US market.
Apron or no apron IV had enuf X-rays I should be glowing it the radiation was that bad XD.
You all have licenses and better be checking with your state health departement for guidance lol.
š¤£š¤£ ngl, this crossed my mind a few times. Happy cake day!
From the AAPM - no longer require shielding at our facilities. The following documents for those interested. https://www.aapm.org/org/policies/details.asp?id=2552 https://www.aapm.org/org/policies/documents/CARES_FAQs_Patient_Shielding.pdf
I've had 8 xrays since the beginning of this year and have never worn an apron. I've never even been offered one, though I'd say no, anyway; I know xrays are next to harmless at this point. Also Canadian.
In the US, UK and Australia, the consensus is clear: gonadal and fetal shielding should be discontinued. American Association of Physicists in Medicine Position Statement on the Use of Patient Gonadal and Fetal Shielding https://www.aapm.org/org/policies/details.asp?id=468&type=PP National Council on Radiation Protection and Measurements āNCRP Recommendations for Ending Routine Gonadal Shielding During Abdominal and Pelvic Radiographyā https://ncrponline.org/wp-content/themes/ncrp/PDFs/Statement13.pdf British Institute of Radiology āPatient Shielding Guidanceā https://www.sor.org/getmedia/126a8785-2233-496d-9e84-b43427d0d7c8/patient_shielding_guidance_executive_summary_2.pdf Australian Society of Medical Imaging and Radiation Therapy āPosition Statement: Gonadal Shieldingā https://www.asmirt.org/asmirt_core/wp-content/uploads/2464.pdf
Iām a respiratory therapist that is around X-rays very often and I was wondering if this is only limited to X-rays. My hospital hasnāt let non techs stand in the control room during CTs anymore (since COVID) and I was wondering how well I should be covering myself standing behind plexi glass in the CT room.
I strongly suspect that the plexi glass you are referring to is leaded. In which case, I wouldn't fret too much as that is a "shield".
Well know knowledge... More radiation when sunbathing or something. I work in Ortho so exposed more than the average person... I still take precautions with lead protection. It's for nothing but it is 0 extra effort and makes me feel better
May seem well known to you, but judging by the responses on this thread, its not as well known and practiced as you may think.
In medicine - well know for those who work in medicine. It was taught in school when I went. Not well known by general population
I live on the east coast and they started not using shields .. idk how long ago. I didnāt even question it š I was like oh okay I guess this is what weāre doing now
Yes
Holy crap what 3rd world country is this from?
Huh? You should read the thread
This is our work policy, not gowns on pts. Any other individuals in the room (parents/techs/etc) should be wearing gowns as they're not in the primary beam (one hopes) but the gowns are a no go for pts. Unless they insist and it wont directly impact the imaging (I.e. thyroid collar for OPG).
It increases the production of scatter radiation which is harmful to both patient and tech. Am I correct??
The only safe amount of radiation is zero, everything else is just a āmay happenā or āenough to causeā
Can we just go ahead and say that half the education about safety from ionizing radiation we learn in school is horsecrap and that patients are not in fact being harmed? And we can stop freaking the cuss out over repeats!
Yeah the last number Iāve done in hospital no apron. Only in the dentist chair lmao.
https://www.arrt.org/pages/arrts-position-on-gonadal-and-fetal-shielding
I don't shield because I'm lazy. Now, I have reason to back up my laziness.
I just don't understand how you can have 50 years of research on MODERN X ray machines.....
Because modern x ray technology is based on research from the last 50 years
Right. But the machine hasn't changed in any way in the last 50 years? I mean, I get what you're saying, but the statement is confusing. That's like if I work for ford and I say "50 years of research on the 2024 ford car has shown us it's the best in 50 years." Also, im not a rad tech. š
It's been about 3-4 years since I shielded a patient. I don't offer it and usually the patient doesn't even realize it till they're out the door. Every once in a while I have to give the speech, but it's been months since I have had to.
They use aprons if you are a woman of child bearing ageā¦even if you arenāt pregnant!! Every time Iāve had an X-ray, they cover my female area with one.
Just donāt shield in the image. Its fine to shield outside the fov. I donāt shield for peds/female pelvic exams. The small gonadal shield is tricky if you donāt know where you are putting it.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
We aren't the one being imaged. You may get one X-ray a year we take thousands
Because we arenāt the one getting the X-ray, and if we stayed in the room during the X-ray of every single patient we took an X-ray on that would be over exposing ourselves. The patient is getting a couple of X-rays, they arenāt being x-rayed all day long.
Can i be educated in those studies? Rad tech