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

Abstract

Objective: As gonad shielding is currently under debate, this study evaluates the practice, from its introduction in about 1905 until today. Methods: The literature was searched for developments in shielding and insights into the effects of ionising radiation on gonads. Based on own pre-1927 dose reconstructions, reported doses after 1927, a 2015-report from the European Union and recent own measurements, the effects of technological evolution and optimisation on radiation dose and hereditary risk were assessed. Results: In the 1900s, gonad shielding was first applied to prevent male sterility, but was discontinued when instrumental developments led to reduced radiation doses. In the 1950s, concerns about hereditary risks intensified and gonad shielding was recommended again, becoming routine worldwide. Imaging-chain improvements over time were considerable: in 2018, the absorbed dose was 0.5% of its 1905 value for the testes and 2% for the ovaries, our optimised effective dose a factor five lower than the value corresponding to the current EU diagnostic reference level, and the reduction in detriment-adjusted risk by shielding less than 1 × 10 −6 for women and 5 × 10 −6 for men. Conclusions: Assessment of pelvic doses revealed a large reduction in radiation risks facilitated by technological developments. Optimisation likewise contributed, but unfortunately, its potential was never adequately exploited. Today, using a modern and optimised X-ray system, gonad shielding can be safely discontinued for women. For men, there might be a marginal benefit, but potential negative side-effects may well dominate. Discontinuation of gonad shielding seems therefore justifiable.

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

“…The K a,i values of this study for the standard and added beam filtrations, 1.6 and 1.2 mGy respectively, are more than double the K a,i values of 0.5-0.6 mGy reported by Jeukens, et al 8 in 2018. The more than double K a,i values in our study are due in part to three differences: (a) The SID of the X-ray Source description A previously developed code for simulating CT source was used by making the tube stationary and adjusting other beam parameters for digital radiography defined in Table II Energy spectra: 1 keV bins from 1-150 keV generated using Spektr3.0 for each tube potential.…”

“…2,7 Due to technical improvements, current clinical radiation doses without gonadal shielding have been estimated to be less than 5% of the values 7 decades ago. 8 In 2018, K a,e values were reported in a European survey of abdominal X-rays of adults of 0.8 AE 0.5 mGy. 8 Despite its stature as a 'gold standard" for more than 50 yr, 9 the practice of gonadal shielding began to be questioned in the last decade as additional data was published.…”

“…8 In 2018, K a,e values were reported in a European survey of abdominal X-rays of adults of 0.8 AE 0.5 mGy. 8 Despite its stature as a 'gold standard" for more than 50 yr, 9 the practice of gonadal shielding began to be questioned in the last decade as additional data was published. 8,[10][11][12][13][14][15] This led to the publication of the American Association of Physicist in Medicine's (AAPM) position statement in 2019 titled: AAPM Position Statement on the Use of Patient Gonadal and Fetal Shielding, 16 which stated in part, "Patient shielding may jeopardize the benefits of undergoing radiological imaging .…”

El fin de la protección gonadal en radiografía de pelvis: Una revisión

“…Para los hombres, puede haber un beneficio marginal, pero los posibles efectos secundarios negativos hacen cuestionar su uso. La interrupción de la protección de las gónadas, por lo tanto, parece justificable en el momento actual (20) . Esto es algo que la profesión radiológica debería tomar en serio dada la orientación y la legislación basados en datos de larga data.…”

“…La evolución tecnológica y la optimización han sido capaces de reducir las dosis de gónadas al 0.5-2% de los valores que se generaban a principios del siglo pasado (aprox. 1905) (20) .…”