Effectiveness of abdominal shields in chest radiography: a Monte Carlo evaluation

Matyagin, Yuri; Collins, Peter

doi:10.1259/bjr.20160465

Cited by 9 publications

(6 citation statements)

References 10 publications

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“…Multiple studies and radiation advisory boards report that the dose to organs outside the FOV is almost entirely from internal scatter generated within the patient, which lead shielding cannot protect against. 5 , 6 , 16 , 44 , 45 , 46 , 47 This research supports the view that shielding anatomy outside the primary beam provides negligible additional radiation protection in terms of breast ESD to the patient. Therefore, this study recommends alternative methods of reducing patient radiation doses, such as primary beam collimation, increasing distance, and the use of the AEC or patient-adapted exposure factors.…”

Section: Discussionsupporting

confidence: 71%

“…14 , 15 , 26 One study has proposed that shielding outside the FOV may contribute to increased patient radiation dose as a result of shielding backscatter that reduces with distance from the primary beam. 44 In contrast, additional radiation dose due to the backscatter from lead shielding was not found in this study, as the addition of outside-FOV shielding or WAL did not significantly increase patient breast ESD for any protocol. However, it must be considered that in the present study, all shielding was placed 5 cm or more from the primary beam.…”

Section: Discussioncontrasting

confidence: 56%

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The effect of breast shielding outside the field of view on breast entrance surface dose in axial X-ray examinations: a phantom study

Hurley¹,

Alashban²,

Albeshan³

et al. 2023

dir

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rotection and optimization of patient radiation doses are key principles in the safe practice of diagnostic radiography. 1 Ionizing radiation can result in deterministic or stochastic effects on biological tissue, 2 and radiation protection serves to eliminate or reduce deterministic effects and render the probability of stochastic effects as low as possible. 3 Lead shielding has been used as a radiation protection tool since low levels of diagnostic radiation became implicated in late radiation responses approximately 80 years ago. 4 Lead (or equivalent) shielding is a radiation protection apparatus that can be directly applied to the patient either inside the field of view (FOV) to reduce the radiation dose to radiosensitive organs, or outside the FOV to protect the patient against scattered radiation. Despite this, several radiation advisory bodies have recently published position statements advocating the curtailment PURPOSEThe purpose of this study was to evaluate the effect of outside-field-of-view (FOV) lead shielding on the entrance surface dose (ESD) of the breast on an anthropomorphic X-ray phantom for a variety of axial skeleton X-ray examinations. METHODSUsing an anthropomorphic phantom and radiation dosimeter, the ESD of the breast was measured with and without outside-FOV shielding in anterior-posterior (AP) abdomen, AP cervical spine, occipitomental 30° (OM30) facial bones, AP lumbar spine, and lateral lumbar spine radiography. The effect of several exposure parameters, including a low milliampere-seconds echnique, grid use, automatic exposure control use, wraparound lead (WAL) use, trolley use, and X-ray table use, on the ESD of the breast with and without outside-FOV shielding was investigated. The mean ESD (μSv) and standard deviation for each radiographic protocol were calculated. A one-tailed Student's t-test was carried out to evaluate whether ESD to the breast was reduced with the use of outside-FOV shielding (P < 0.05). RESULTSA total of 920 breast ESD measurements were recorded across the different protocol parameters. The largest decrease in mean ESD of the breast with outside-FOV shielding was 0.002 μSv (P = 0.084), recorded in the AP abdomen on the table with a grid, OM30 on the table with a grid, OM30 standard protocol on the trolley, and OM30 on the trolley with WAL protocols. This decrease was found to be statistically non-significant. CONCLUSIONThis study found no significant decrease in the ESD of the breast with the use of outside-FOV shielding for the AP abdomen, AP cervical spine, OM30 facial bones, AP lumbar spine, or lateral lumbar spine radiography across a range of protocols.

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Section: Discussionsupporting

confidence: 71%

Section: Discussioncontrasting

confidence: 56%

The effect of breast shielding outside the field of view on breast entrance surface dose in axial X-ray examinations: a phantom study

Hurley¹,

Alashban²,

Albeshan³

et al. 2023

dir

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show abstract

“…In case of CT, this number represents a rather low contribution compared to the total dose of a head CT. In addition, out-of-plane shielding does not protect from internal scattering, which is the main contributing source of the radiation dose to internal organs located outside of the field of view (FoV) [8,58,59]. For external scatter, the effectiveness of the shielding depends on its position relative to the beam edge.…”

Section: Out-of-plane Shieldingmentioning

confidence: 99%

Systematic literature review on the benefit of patient protection shielding during medical X-ray imaging: Towards a discontinuation of the current practice

et al. 2022

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Patient shielding during medical X-ray imaging has been increasingly criticized in the last years due to growing evidence that it often provides minimal benefit and may even compromise image quality. In Europe, and as also shown in a short assessment in Switzerland, the use of patient shielding is inhomogeneous. The aim of this study was to systematically review recent literature in order to assess benefits and appraise disadvantages related to the routine use of patient shielding. Methods: To evaluate benefits and disadvantages related to the application of patient shielding in radiological procedures, a systematic literature review was performed for CT, radiography, mammography and fluoroscopyguided medical X-ray imaging. In addition, reports from medical physics societies and authorities of different countries were considered in the evaluation. Results: The literature review revealed 479 papers and reports on the topic, from which 87 qualified for closer analysis. The review considered in-and out-of-plane patient shielding as well as shielding for pregnant and pediatric patients. Dose savings and other dose and non-dose related effects of patient shielding were considered in the evaluation. Conclusions: Although patient shielding has been used in radiological practice for many years, its use is no longer undisputed. The evaluation of the systematic literature review of recent studies and reports shows that dose savings are rather minimal while significant dose-and non-dose-related detrimental effects are present. Consequently, the routine usage of patient protection shielding in medical X-ray imaging can be safely discontinued for all modalities and patient groups.

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“…A previous study reported that the scatter radiation from the table could be reduced by increasing the distance between the table and the skin (14) . Another similar study reported that the same method could be applied to decrease the scattered X-ray that occurs from the radiationshielding material (15)(16)(17) .…”

Section: Discussionmentioning

confidence: 99%

Changing the entrance surface dose and image quality by applying an air mattress to the table commonly used in computed tomography

Park

Kim²

2022

Int J Radiat Res

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Background: In this study, the changes in the entrance surface dose (ESD) and image quality were examined when an air mattress was used to reduce the X-ray scattering caused by treatment tables commonly used for computed tomography (CT). Materials and Methods: Dual-energy CT (DECT) was used, with the ESD of Alderson Radiation Therapy (ART) phantom measured by scanning with different X-ray tube voltages and X -ray tube currents for three scenarios: when no air mattress was employed, and when a 5 cm or 10 cm thick air mattress was employed. The statistical significance of the changes in ESD and image quality were based on the presence and thickness of the air mattress. Additionally, the variations of the X-ray tube voltage and current for different air mattress thicknesses were investigated using paired t-test. Results: For all X-ray tube voltages and currents, applying an air mattress significantly improved both the ESD and image quality, with the 5 cm air mattress improving both the ESD and image quality. Conclusion: The 5 cm air mattress produced no artifacts in the diagnostic images, and demonstrated a statistically significant reduction in patient ESD during DECT imaging.

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Effectiveness of abdominal shields in chest radiography: a Monte Carlo evaluation

Cited by 9 publications

References 10 publications

The effect of breast shielding outside the field of view on breast entrance surface dose in axial X-ray examinations: a phantom study

The effect of breast shielding outside the field of view on breast entrance surface dose in axial X-ray examinations: a phantom study

Systematic literature review on the benefit of patient protection shielding during medical X-ray imaging: Towards a discontinuation of the current practice

Changing the entrance surface dose and image quality by applying an air mattress to the table commonly used in computed tomography

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