xray-edmonton

Discontinuing the Use of Lead Shielding for Routine Diagnostic Imaging

MIC Medical Imaging will no longer use routine lead shielding in diagnostic imaging exams like x-ray. Historically, lead shielding has been seen as an important precaution in reducing radiation exposure to non-targeted areas of the body and an important component of the “As Low As Reasonably Achievable” (ALARA) principle.23

While this policy change may seem surprising, various organizations both locally and internationally have made adjustments to align with new imaging recommendations.

So, what changed since the last time you had an x-ray?

There are three main reasons why we no longer recommend gonadal and fetal shielding during routine diagnostic imaging exams like x-ray.

Decades of Research

Today’s data shows negligible benefit for the patient or fetus. In 70 years of research, no studies have proven the harmful effects of x-rays on reproductive organs or the fetus (unborn baby) during diagnostic imaging. However, studies have shown that the human body is not as sensitive to radiation as we used to believe. 5,14,15,20,21

Technological Advancements

Medical imaging technology has improved dramatically over the decades. On average, patients receive 20-25 times less radiation than they did in the 1950s.5,12,15

Our Bodies Are Unique

Different compositions and physiology can cause shielding to be easily misplaced. Poorly placed shielding can drastically impact the quality of the x-ray. 8,9,16,17,19 Furthermore, there is a risk that the lead shielding will obscure anatomy that is important for an accurate diagnosis and cause the procedure to be repeated. 11

The Healthcare Community

The following organizations have implemented the same changes or publicly support the movement away from lead shielding in routine diagnostic imaging exams like x-ray:

MIC’s Position

MIC is a trusted partner to Edmonton’s primary care practitioners, specialists, and surrounding communities. We are dedicated to making a difference in the lives of our patients, which means we must constantly evaluate policies, procedures, industry standards, and best practices.

Since shielding can introduce unnecessary risks and provides no benefit to a patient’s health, our leadership, radiologists, and Radiography Coordinator believe there is sufficient evidence to change our shielding policy. 

Lead Shielding FAQ

If you have additional questions or concerns about our new shielding policy, we encourage you to talk to your doctor or medical radiation technologist (MRT) before your exam.
Modern medical imaging technology uses 20-25 times less radiation than conventional x-ray imaging equipment used in the 1950s. Therefore, lead shielding provides negligible protection when the radiation exposure is so small.
Shielding may cover up important organs near the area of interest your practitioner needs to see for their diagnosis. If your practitioner wants to examine organs hidden by the shielding, we may have to repeat the exam.
Yes, children are more sensitive to radiation. However, the amount of radiation used to x-ray your child is not the same as an adult. Our team of experts will adjust our doses and procedures accordingly. Furthermore, your doctor has determined that the benefit from having the information from an x-ray is much higher than the risk from radiation exposure, which is essentially zero.
MIC closely follows the ALARA principle - an industry-standard in healthcare. The goal of ALARA is to minimize radiation exposure and ensure there is a medical or diagnostic purpose for every exam. Since your child needs an x-ray, there is a reasonable justification for radiation exposure. As outlined in this post, shielding your child during an x-ray provides negligible benefit and can lead to repeat exams. However, there is no reason to expose yourself or our staff to unnecessary radiation during the exam. Therefore, adhering to the ALARA principle, we will always provide lead shielding to our staff and guests within the exposure field.
The acute radiation dose in a single x-ray exam is exponentially less than the required single-dose exposure before infertility becomes a concern. 18 Based on decades of research, advancements in medical imaging technology, and risk-reward evaluations from your doctor and our radiologists, we are confident in performing x-ray imaging exams without gonadal shielding.
No. Both the American Association of Physicists in Medicine (AAPM) and the American College of Obstetricians and Gynecologists (ACOG) state that the amount of radiation used in medical imaging like x-ray is much lower than what can cause harm to a fetus or its development. Additionally, lead shielding may cover up parts of your body that your practitioner needs to see.6 If your practitioner is missing information, the exam may have to be repeated.
American Association of Physicists in Medicine (AAPM). AAPM position statements, policies and procedures - Details. Accessed May 13, 2020. https://www.aapm.org/org/policies/details.asp?id=468&type=PP
American College of Radiology (ACR). ACR-AAPM-SIIM-SPR Practice parameter for digital radiography. Resolution 40. Published 2018. Accessed May 13, 2020. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Rad-Digital.pdf
American College of Radiology (ACR). ACR-SPR. Practice parameter for imaging pregnant or potentially pregnant adolescents and women with ionizing radiation. Resolution 39. Published 2018. Accessed May 13, 2020. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Pregnant-Pts.pdf
Bjarnason TA, Rees R, Kainz J, et al. COMP report: A survey of radiation safety regulations for medical imaging x-ray equipment in Canada. J Appl Clin Med Phys. 2020;21(3):10-19. doi:10.1002/acm2.12708
Billings MS, Norman A, Greenfield MA. Gonad dose during routine roentgenography. Radiology. 1957;69(1):37-41. doi:10.1148/69.1.37
Brent, R. L., Frush, D. P., Harms, et al. (2013). Preconception and Prenatal Radiation Exposure: Health Effects and Protective Guidance Recommendations of the National Council on Radiation Protection and Measurements.
Dauer LT, Thornton RH, Hay JL, Balter R, Williamson MJ, St. Germain J. Fears, feelings, and facts: Interactively communicating benefits and risks of medical radiation with patients. AJR Am J Roentgenol. 2011;196(4). doi:10.2214/AJR.10.5956
Fawcett SL, Barter SJ. The use of gonad shielding in paediatric hip and pelvis radiographs. Br J Radiol. 2009;82(977):363-370. doi:10.1259/bjr/86609718
Fawcett SL, Gomez AC, Barter SJ, Ditchfield M, Set P. More harm than good? The anatomy of misguided shielding of the ovaries. Br J Radiol. 2012;85(1016):e442-447. doi:10.1259/bjr/25742247
Frantzen MJ, Robben S, Postma AA, Zoetelief J, Wildberger JE, Kemerink GJ. Gonad shielding in paediatric pelvic radiography: Disadvantages prevail over benefit. Insights Imaging. 2011;3(1):23-32. doi:10.1007/s13244-011-0130-3
Frantzen, M. J., Robben, S., Postma, A. A., Zoetelief, J., Wildberger, J. E., & Kemerink, G. J. (2012). Gonad shielding in paediatric pelvic radiography: disadvantages prevail over benefit. Insights Imaging, 3, 23–32.
Handloser JS, Love RA. Radiation doses from diagnostic x-ray studies. Radiology. 1951;57(2):252-254. doi:10.1148/57.2.252
International Atomic Energy Agency. Radiation protection and safety in medical uses of ionizing radiation, specific safety guide no. SSG-46. Accessed May 13, 2020. https://www-pub.iaea.org/MTCD/Publications/PDF/PUB1775_web.pdf
International Commission on Radiological Protection. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP. 2007;37(2-4):1-332. doi:10.1016/j.icrp.2007.10.003
Jeukens CRLPN, Kütterer G, Kicken PJ, et al. Gonad shielding in pelvic radiography: Modern optimised x-ray systems might allow its discontinuation. Insights Imaging. 2020;11. doi:10.1186/s13244-019-0828-1
Karami V, Zabihzadeh M, Shams N, Saki Malehi A. Gonad shielding during pelvic radiography: A systematic review and meta-analysis. Arch Iran Med. 2017;20(2):113-123. doi:0172002/AIM.0011
Kenny N, Hill J. Gonad protection in young orthopaedic patients. BMJ. 1992;304(6839):1411-1413.
Lee, M. C., Lloyd, J., & Solomito, M. J. (2017). Poor Utility of Gonadal Shielding for Pediatric Pelvic Radiographs. Orthopedics, 40(4), e623–e627.
Liakos P, Schoenecker PL, Lyons D, Gordon JE. Evaluation of the efficacy of pelvic shielding in preadolescent girls. J Pediatr Orthop. 2001;21(4):433-435.
Marsh RM, Silosky M. Patient shielding in diagnostic imaging: Discontinuing a legacy practice. Am J Roentgenol. 2019;212(4):755-757. doi:10.2214/AJR.18.20508
National Research Council. Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. Published 2006. Accessed May 13, 2020. https://scholar.google.com/scholar_lookup?hl=en&publication_year=2006&author=National+Research+Council&title=Health+risks+from+exposure+to+low+levels+of+ionizing+radiation%3A+BEIR+VII+phase+2.
Oikarinen HT, Perttu AM, Mahajan HM, et al. Parents' received and expected information about their child's radiation exposure during radiographic examinations. Pediatr Radiol. 2019;49(2):155-161. doi:10.1007/s00247-018-4300-z
Strauss KJ, Kaste SC. The ALARA (as low as reasonably achievable) concept in pediatric interventional and fluoroscopic imaging: Striving to keep radiation doses as low as possible during fluoroscopy of pediatric patients. Pediatr Radiol. 2006;36(Suppl 2):110-112. doi:10.1007/s00247-006-0184-4
Wainwright AM. Shielding reproductive organs of orthopaedic patients during pelvic radiography. Ann R Coll Surg Engl. 2000;82(5):318-321.
Warlow T, Walker-Birch P, Cosson P. Gonad shielding in paediatric pelvic radiography: Effectiveness and practice. Radiography. 2014;20(3):178-182. doi:10.1016/j.radi.2014.01.002