Should I Be Shielded During Radiologic Imaging?

If you’ve had X-ray imaging done in the past, you may remember having a lead shield laid over part of your body to prevent radiation from reaching areas that are not being imaged. In the 1950s, radiologists began shielding patients’ reproductive organs as well as the wombs of pregnant patients because they were unsure what long-term effects X-ray exposure may have on reproductive cells or a developing fetus.

What has changed?

Since that time, both imaging technology and the understanding of how radiation affects the body have evolved. Currently, professional organizations including the American College of Radiology (ACR), the Radiological Society of North America (RSNA), and the American Association of Physicists in Medicine (AAPM) recommend against reproductive and fetal shielding. Similarly, the Iowa Department of Public Health has eliminated its requirement to shield reproductive organs when they are exposed to X-rays during imaging.

Technological Advances

The imaging devices that hospitals and clinics currently use expose patients to much less radiation than older models. New low-dose X-ray technologies, such as those often used for 3D mammography and CT lung cancer screening, significantly reduce the amount of radiation delivered during exams. Generally speaking, X-ray exams today use only about 5% of the radiation of those used in the 1950s.

Medical Understanding

The scientific community’s understanding of how radiation affects the human body is much more sophisticated than it was in the 1950s. Evidence gathered over the intervening decades suggests that routine diagnostic imaging does not result in harmful levels of radiation exposure to a patient or their developing fetus. In fact, Rebecca Marsh, medical physicist at the University of Colorado Anschutz Medical Campus in Aurora, Colorado, points out that there is “no evidence that fetuses are harmed by even a relatively high amount of radiation exposure, such as that from a CT scan of the abdomen.” Likewise, research has shown no evidence that imaging damages reproductive organs.

Surprisingly, what the evidence does show is that shielding can actually result in a higher radiation dose during an exam. This can happen a couple of different ways:

• Shields can inadvertently obscure areas that need to be imaged, due either to patient movement or improper placement, requiring more images to be taken.
• A shield can cause a machine’s automatic exposure controls to deliver higher amounts of radiation in an attempt to penetrate it.

Additionally, lead shields cannot protect patients’ reproductive organs or fetuses from radiation scatter, which occurs as a result of radiation ricocheting around the body after it’s been directed at a specific area of interest. Scatter is an unavoidable part of X-ray examination, but because this radiation dose is so low, doctors do not consider it cause for concern.

If it’s safe, why do the technologists shield themselves?

Radiologic technologists work around X-rays every day. Without shielding, their exposure would be much greater than that of their patients. As a result, experts recommend that health care workers continue to use lead barriers to protect themselves from the occupational hazard of regular exposure.

At Iowa Radiology, we’re committed to the highest standards of patient care. As such, we are aligning our practices with the recommendations of the ACR, the RSNA, and the AAPM. As always, we will adhere to the principle of ALARA (“as low as reasonably achievable”) that guides the use of radiation in imaging. If you ever have a question about how we protect your safety during an exam at our clinics, please don’t hesitate to ask. We are happy to provide all the information you need to feel confident about your care. To learn more about specific exams, including CT, mammography, and MRI, see our free resource library.

Resources

Iowa Department of Public Health. Fact Sheet Regarding Gonadal Shielding for Diagnostic Radiology Applications. Published May 14, 2022. Accessed September 9, 2022. https://idph.iowa.gov/Portals/1/userfiles/305/FS%20for%20Diagnostic%20Radiology%20Applications%20Gonadal%20Shielding.pdf

Jaklevic MC. No Shield from X-Rays: How Science Is Rethinking Lead Aprons. KHN.org. Published January 5, 2020. Accessed September 9, 2022. https://khn.org/news/no-shield-from-x-rays-how-science-is-rethinking-lead-aprons/

Radiological Society of North America. Fetal and Gonadal Shielding. Radiologyinfo.org. Published April 15, 2022. Accessed September 9, 2022. https://www.radiologyinfo.org/en/info/safety-patient-shielding

Raven K. Wait—Now I Don't Need a Pelvic Shield During X-Rays? YaleMedicine.org. Published March 8, 2021. Accessed September 9, 2022. https://www.yalemedicine.org/news/dont-need-pelvic-shield-during-x-rays