Skip to main content
SpringerLink
Log in

Female gonadal shielding with automatic exposure control increases radiation risks

Pediatric Radiology volume 48, pages 227–234 (2018)Cite this article

Abstract

Background

Gonadal shielding remains common, but current estimates of gonadal radiation risk are lower than estimated risks to colon and stomach. A female gonadal shield may attenuate active automatic exposure control (AEC) sensors, resulting in increased dose to colon and stomach as well as to ovaries outside the shielded area.

Objective

We assess changes in dose–area product (DAP) and absorbed organ dose when female gonadal shielding is used with AEC for pelvis radiography.

Materials and methods

We imaged adult and 5-year-old equivalent dosimetry phantoms using pelvis radiograph technique with AEC in the presence and absence of a female gonadal shield. We recorded DAP and mAs and measured organ absorbed dose at six internal sites using film dosimetry.

Results

Female gonadal shielding with AEC increased DAP 63% for the 5-year-old phantom and 147% for the adult phantom. Absorbed organ dose at unshielded locations of colon, stomach and ovaries increased 21–51% in the 5-year-old phantom and 17–100% in the adult phantom. Absorbed organ dose sampled under the shield decreased 67% in the 5-year-old phantom and 16% in the adult phantom.

Conclusion

Female gonadal shielding combined with AEC during pelvic radiography increases absorbed dose to organs with greater radiation sensitivity and to unshielded ovaries. Difficulty in proper use of gonadal shields has been well described, and use of female gonadal shielding may be inadvisable given the risks of increasing radiation.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Ardran GM, Crooks HE (1957) Gonad radiation dose from diagnostic procedures. Br J Radiol 30:295–297

    Article  CAS  PubMed  Google Scholar 

  2. Stanford RW, Vance J (1955) The quantity of radiation received by the reproductive organs of patients during routine diagnostic X-ray examinations. Br J Radiol 28:266–273

    Article  CAS  PubMed  Google Scholar 

  3. Abram E, Wilkinson DM, Hodson CJ (1958) Gonadal protection from X radiation for the female. Br J Radiol 31:335–3365

    Article  CAS  PubMed  Google Scholar 

  4. Adran GM, Kemp FH (1957) Protection of the male gonads in diagnostic procedures. Br J Radiol 30:280

    Article  CAS  PubMed  Google Scholar 

  5. Feldman A, Babcock GC, Lanier RR et al (1958) Gonadal exposure dose from diagnostic X-ray procedures. Radiology 71:197–207

    Article  CAS  PubMed  Google Scholar 

  6. International Commission on Radiological Protection (1977) ICRP publication 26: recommendations of the ICRP. Ann ICRP 1

  7. International Commission on Radiological Protection (1991) ICRP publication 60: 1990 recommendations of the ICRP. Ann ICRP 21

  8. International Commission on Radiological Protection (2007) ICRP publication 103: the 2007 recommendations of the International Commission on Radiological Protection. Ann ICRP 37:1–332

    Google Scholar 

  9. Rossi RP, Lin P-JP, Rauch PL et al (1985) AAPM report 14: performance specifications and acceptance testing for X-ray generators and automatic exposure control devices. American Association of Physicists in Medicine, New York

    Google Scholar 

  10. Kaplan SL, Magill D, Felice MA et al (2017) Intussusception reduction: effect of air vs. liquid enema on radiation dose. Pediatr Radiol. https://doi.org/10.1007/s00247-017-3902-1

  11. Wang ZJ, Chen KS, Gould R et al (2011) Positive enteric contrast material for abdominal and pelvic CT with automatic exposure control: what is the effect on patient radiation exposure? Eur J Radiol 79:e58–e62

    Article  PubMed  PubMed Central  Google Scholar 

  12. Paul J, Schell B, Kerl JM et al (2011) Effect of contrast material on image noise and radiation dose in adult chest computed tomography using automatic exposure control: a comparative study between 16-, 64- and 128-slice CT. Eur J Radiol 79:e128–e132

    Article  PubMed  Google Scholar 

  13. Nguyen KK, Schlaifer AE, Smith DL et al (2012) In automated fluoroscopy settings, does shielding affect radiation exposure to surrounding unshielded tissues? J Endourol 26:1489–1493

    Article  PubMed  Google Scholar 

  14. Persliden J, Schuwert P, Mortensson W (1996) Comparison of absorbed radiation doses in barium and air enema reduction of intussusception: a phantom study. Pediatr Radiol 26:329–332

    Article  CAS  PubMed  Google Scholar 

  15. Herrmann TL, Fauber TL, Gill J et al (2012) White paper: best practices in digital radiography. American Society of Radiologic Technologists. https://www.asrt.org/docs/default-source/publications/whitepapers/asrt12_bstpracdigradwhp_final.pdf. Accessed 17 Aug 2017

  16. Goske MJ, Charkot E, Herrmann T et al (2011) Image Gently: challenges for radiologic technologists when performing digital radiography in children. Pediatr Radiol 41:611–619

    Article  PubMed  Google Scholar 

  17. Kenny N, Hill J (1992) Gonad protection in young orthopaedic patients. BMJ 304:1411–1413

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Palmer SH, Starritt HC, Paterson M (1998) Radiation protection of the ovaries in young scoliosis patients. Eur Spine J 7:278–281

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Wainwright AM (2000) Shielding reproductive organs of orthopaedic patients during pelvic radiography. Ann R Coll Surg Engl 82:318–321

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Liakos P, Schoenecker PL, Lyons D et al (2001) Evaluation of the efficacy of pelvic shielding in preadolescent girls. J Pediatr Orthop 21:433–435

    CAS  PubMed  Google Scholar 

  21. McCarty M, Waugh R, McCallum H et al (2001) Paediatric pelvic imaging: improvement in gonad shield placement by multidisciplinary audit. Pediatr Radiol 31:646–649

    Article  CAS  PubMed  Google Scholar 

  22. Sikand M, Stinchcombe S, Livesley PJ (2003) Study on the use of gonadal protection shields during paediatric pelvic X-rays. Ann R Coll Surg Engl 85:422–425

    Article  PubMed  PubMed Central  Google Scholar 

  23. Gul A, Zafar M, Maffulli N (2005) Gonadal shields in pelvic radiographs in pediatric patients. Bull Hosp Jt Dis 63:13–14

    PubMed  Google Scholar 

  24. Bardo DM, Black M, Schenk K et al (2009) Location of the ovaries in girls from newborn to 18 years of age: reconsidering ovarian shielding. Pediatr Radiol 39:253–259

    Article  PubMed  Google Scholar 

  25. Fawcett SL, Gomez AC, Barter SJ et al (2012) More harm than good? The anatomy of misguided shielding of the ovaries. Br J Radiol 85:e442–e447

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Fawcett SL, Barter SJ (2009) The use of gonad shielding in paediatric hip and pelvis radiographs. Br J Radiol 82:363–370

    Article  CAS  PubMed  Google Scholar 

  27. Frantzen MJ, Robben S, Postma AA et al (2012) Gonad shielding in paediatric pelvic radiography: disadvantages prevail over benefit. Insights Imaging 3:23–32

    Article  PubMed  Google Scholar 

  28. Lee MC, Lloyd J, Solomito MJ (2017) Poor utility of gonadal shielding for pediatric pelvic radiographs. Orthopedics 40:e623–e627

    Article  PubMed  Google Scholar 

  29. Karami V, Zabihzadeh M, Shams N, Saki Malehi A (2017) Gonad shielding during pelvic radiography: a systematic review and meta-analysis. Arch Iran Med 20:113–123

    PubMed  Google Scholar 

  30. Winfeld M, Strubel N, Pinkney L et al (2013) Relative distribution of pertinent findings on portable neonatal abdominal radiographs: can we shield the gonads? Pediatr Radiol 43:1295–1302

    Article  PubMed  Google Scholar 

  31. American College of Radiology, Society for Pediatric Radiology (2014) ACR-SPR practice parameter for general radiography, amended 2014. Vol RES 30–2013 (Res 39)

  32. Khong PL, Ringertz H, Donoghue V et al (2013) ICRP publication 121: radiological protection in paediatric diagnostic and interventional radiology. Ann ICRP 42:1–63 http://www.icrp.org/publication.asp?id=ICRP%20Publication%20121

    Article  PubMed  Google Scholar 

  33. Don S (2004) Radiosensitivity of children: potential for overexposure in CR and DR and magnitude of doses in ordinary radiographic examinations. Pediatr Radiol 34:S167–S172

    Article  PubMed  Google Scholar 

  34. Kaplan SL, Magill D, Felice MA et al (2015) Lead gonad shields: good or bad for patient radiation exposure? Pediatr Radiol 45:S89–S90

    Google Scholar 

Download references

Acknowledgements

The authors acknowledge Eatrice Hinton, RT, and Colleen Flowers, RT, for technical assistance and manuscript review.

Author information

Authors and Affiliations

  1. Department of Radiology, The Children’s Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Summer L. Kaplan & Xiaowei Zhu

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Summer L. Kaplan & Xiaowei Zhu

  3. Environmental Health and Radiation Safety, University of Pennsylvania, Philadelphia, PA, USA

    Dennise Magill & Marc A. Felice

  4. Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA

    Rui Xiao

  5. Department of Radiology, Temple University Hospital, Philadelphia, PA, USA

    Sayed Ali

Authors
  1. Summer L. Kaplan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dennise Magill
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marc A. Felice
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rui Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sayed Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiaowei Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Summer L. Kaplan.

Ethics declarations

Conflicts of interest

None

Appendix 1 Calibration curve

Appendix 1 Calibration curve

figure a

This calibration curve was used to determine absorbed dose from film dosimeters implanted in the phantoms. To make the curve, we exposed film samples (Gafchromic, Ashland) together with a solid state radiation detector (Black Piranha with an external T20 dose probe; RTI Group AB, Sweden) to multiple known amounts of radiation between 2.17 and 124.4 mGy. The solid state detector is calibrated on a 2-year cycle by the manufacturer’s accredited calibration laboratory (ISO/IEC 17025). During calibration the detector is compared to a reference ion chamber, which is traceable through PTB (Germany) to national or international measurement standards. The standard uncertainty of measurement is in compliance with EAL Publication EA-4/02 and is ±1.4% at standard reference condition. The uncertainty increases to ±2.7% when the T20 probe is used with a calibrated Piranha for radiation dose measurements. We measured film green values from these exposures and fit the calibration green values to a three-parameter hyperbolic decay curve as above, where y = film darkening, or mean green value, and x= absorbed dose in mGy. The film was scanned using a commercially available flatbed optical scanner (Mustek Systems Inc., Taiwan). The resultant images were evaluated with ImageJ 1.48v software (National Institutes of Health, Bethesda, MD), and the curve fit for the data was analyzed using Sigma Plot 13 (Systat Software Inc., San Jose, CA). The coefficient of determination R2=0.996, indicated that the exponential decay function fit the calibration data well. We calculated absorbed dose in our experiments by locating the mean green values of our exposed films along this calibration curve.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kaplan, S.L., Magill, D., Felice, M.A. et al. Female gonadal shielding with automatic exposure control increases radiation risks. Pediatr Radiol 48, 227–234 (2018). https://doi.org/10.1007/s00247-017-3996-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-017-3996-5

Keywords

search

Navigation