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

Abstract

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.

Factors affecting radiographers’ use of dose-reduction measures

“…The study found that the strength of the safety culture appears to be an important factor influencing the likelihood of using gonad shielding. Use of gonad shielding has been a topic of debate among medical professionals in the field of radiology [17,18], and, just recently, a statement from the European professional societies on patient shielding was issued in which the recommendation was not to apply gonad shielding [19]. The Swedish Radiation Safety Authority has not yet changes their recommendations accordingly.…”

Efficiency evaluation of leaded glasses and visors for eye lens dose reduction during fluoroscopy guided interventional procedures

“…This estimation allowed us to improve the radiation protection advice in cases where other protection may not be available or cannot be employed. Moreover, the use of radiation protection means for the patient has recently been re-evaluated and its use may even increase the dose to the patient and personnel, especially in complex procedures such as the interventional ones [17][18][19][20].…”

Estimasi Dosis Radiasi Pada Pasien Pemeriksaan Percutaneous Coronary Interventions (Pci) Di RSUP Prof.Dr. I.G.N.G Ngoerah

“…Hal ini karena pemeriksaan PCI dilakukan dengan menggunakan fluoroskopi dengan durasi fluorotime yang relatif lama. Dengan meluasnya radiologi intervensi dan potensi resiko radiasi yang besar dalam intervensi maka staf dan pasien di fasilitas radiologi intervensi memerlukan sistem proteksi radiasi yang sesuai (Maslebu et al, 2017;Samara et al, 2022;.…”

“…Nilai DRL Nasional ditentukan pada nilai kuartil 3 (75 persentil) dari data sebaran dosis yang didapat dari fasilitas (K. L. Lee et al, 2020). Indikator Dosis radiasi yang dapat mendeskripsikan DRL pada fluoroskopi konvensional dan intervensional itu berupa DAP atau KAP (Gy.cm 2 ) atau Peak Skin Dose (mGy) atau laju kerma udara (mGy) (MILLER et al, 2021;Samara et al, 2022) . dan untuk nilai DRL Air Kerma bernilai 906 mGy (Schegerer et al, 2019).…”