Answer to Question #14742 Submitted to "Ask the Experts"

Category: Medical and Dental Equipment and Shielding — Shielding

The following question was answered by an expert in the appropriate field:

Q

My six-year-old son just had a barium fluoroscopy swallow study, and we didn't think about it at the time, but noticed that they didn't place a gonadal shield apron over him during the procedure. Is this something we should be worried about?

A

This is a question that is becoming more common, partially due to the history of gonadal shielding which goes back decades, and also because the use of gonadal shielding has become unnecessary and is on the decline for a number of reasons. On 2 April 2019, the American Association of Physicists in Medicine (AAPM) published policy statement PP 32-A that recommended the discontinuation of gonadal shielding for diagnostic x-ray procedures. The main portions of that policy statement include the following major points:

  1. Gonadal shielding provides negligible, or no, benefit to patients' health. Radiation doses from diagnostic procedures have not been shown to result in any increased risk of hereditary effects. As cited in the AAPM position statement, this was actually mentioned back in 2007 in Publication 103 from the International Commission on Radiological Protection (ICRP). In that publication, the ICRP states that "no human studies provide direct evidence of a radiation-associated excess of heritable disease." Furthermore, most of the radiation dose to organs in the body come from internal scatter (i.e., radiation "bouncing" around inside the body) when the gonads are not in the primary field of view (i.e., not in the main x-ray beam). Thus, placing a shield over the gonads when they aren't in the field of view really does nothing to reduce the radiation dose from this internal scattering.
  2. The use of gonadal shielding can negatively affect the efficacy of the exam. Shielding could obscure anatomy that the physician needs to see to make an appropriate diagnosis. If shielding is used and obstructs the physician's view, it might be necessary to repeat the examination which would increase the overall radiation dose to the patient. Modern x-ray imaging systems use "automatic exposure control" which essentially means that the x-ray machine adjusts its parameters to provide the best possible image. When shielding is placed in the field of view, the x-ray machine can drastically increase the x-ray output which increases the patient's overall radiation dose and can also degrade the image quality.

Following publication of AAPM's PP 32-A, a number of other professional groups (American College of Radiology, Radiological Society of North America, Health Physics Society, Canadian Association of Radiologist, et.al.) supported and endorsed the AAPM's position. About the only time the use of gonadal shielding for diagnostic x-ray procedures is recommended is if the patient simply refuses to have the procedure performed without such shielding. In that case, not having the procedure performed is the predominant risk to the patient's health.

It isn't clear that your son's gonads would have been in the field of view from the barium fluoroscopy study, but as indicated above, even if his gonads were in the field of view, the risk from such a low dose of radiation is practically non-existent and the use of gonadal shielding would have either been of no benefit, or possibly detrimental to achieving a high-quality image.

Mack L. Richard, MS, CHP

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