Answer to Question #15163 Submitted to "Ask the Experts"

I had a chronic hip injury after pregnancy. My doctor ordered a pelvic/hip x ray. I needed to have a follow-up pelvic/hip x ray after eight weeks. Everything is fine. Should I be worried that this is a lot of unnecessary radiation to my reproductive organs? The x rays were taken at different facilities. In both cases the technologist did not put any shielding on my upper body/gonad area. Why wouldn't they shield me?

I want to begin by reassuring you that the amount of radiation used for your pelvic/hip x ray is too small to cause harm, and shielding provides very little or no benefit. 

There has been a change in practice at facilities nationwide to stop using lead shielding routinely on patients. It has been demonstrated in the literature that there is minimal or no benefit to using shielding on patients when the part of the body being shielded is not in the image. The x-ray beam for imaging is very carefully collimated so that only the area being imaged receives measurable radiation. There is some scatter, but nearly all of it is inside the patient's body and the lead apron on the outside of the patient doesn't make any difference. Also, the use of shielding can result in the patient receiving more radiation. If the shielding gets in the x-ray beam, it can cover anatomy that needs to be seen by the physician or cause imaging artifacts. That leads to imaging being repeated far too often. Lead in the imaging field also causes the equipment to automatically increase the x-ray output, which increases patient dose. With an x ray of the hip and pelvis, the risk is high that the shielding could slip into the imaging field. The technologist should have adjusted the size of the x ray to ensure that only the anatomy needed was in the image to minimize dose to the reproductive tissues. After a lot of study and discussion, it became clear that use of shielding has negligible or no benefit and can lead to higher patient radiation doses.

In April 2019,the American Association of Physicists in Medicine (AAPM) issued a Position Statement on the Use of Patient Gonadal Shielding which has been endorsed by several organizations, including the Health Physics Society and the American College of Radiology. The change in practice was made to improve patient care. AAPM has also provided answers to frequently asked questions about patient shielding.

I hope this helps you to be more comfortable with the change in practice and relieves your worry about your radiation exposure.

Deirdre H. Elder, MS, CHP, CMLSO