Patient gonadal and fetal shielding during X-ray based diagnostic imaging should be discontinued as routine practice. Patient shielding may jeopardize the benefits of undergoing radiological imaging. Use of these shields during X-ray based diagnostic imaging may obscure anatomic information or interfere with the automatic exposure control of the imaging system. These effects can compromise the diagnostic efficacy of the exam, or actually result in an increase in the patient’s radiation dose. Because of these risks and the minimal to nonexistent benefit associated with fetal and gonadal shielding, AAPM recommends that the use of such shielding should be discontinued.
For patients or guardians experiencing fear and anxiety about radiation exposure, the use of gonadal or fetal shielding may calm and comfort the patient enough to improve the exam outcome (1). This may be considered when developing shielding policies and procedures. However, blanket statements requiring the use of such shielding are not supported by current evidence (2-4). Additionally, the AAPM recommends that radiologic technologist educational programs (including patient outreach efforts) provide information about the limited utility and potential drawbacks of gonadal and fetal shielding.
Rationale for policy: Gonadal and fetal shielding in X-ray imaging has for decades been considered consistent with the ALARA principle and therefore good practice. Given advances in technology and current evidence of radiation exposure risks, the AAPM has reconsidered the effectiveness of gonadal and fetal shielding.
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Gonadal and fetal shielding provide negligible, or no, benefit to patients’ health.
1) Radiation doses used in diagnostic imaging are not associated with measurable harm to the gonads or fetus. The main concern with radiation exposure to the reproductive organs has been an increased risk of hereditary effects. However, according to the 2007 Publication 103 of the International Commission on Radiological Protection (ICRP), “no human studies provide direct evidence of a radiation-associated excess of heritable disease” (5). Similarly, the American College of Obstetricians and Gynecologists (ACOG) Guidelines, with endorsement from the American College of Radiology (ACR), states that “with few exceptions, radiation exposure through radiography, computed tomography scan, or nuclear medicine imaging techniques is at a dose much lower than the exposure associated with fetal harm” (6).