Updated Radiology Shielding Guidelines
This change in practice is based on many years of research which have shown that levels of radiation used in modern x-ray exams are so low that the risk of harm is very small or zero. These studies conclude that shields have no added benefit for patient safety.
Updated scientific research in the radiation safety field along with changes in imaging technology has led us to discontinue the practice of patient shielding during x-ray imaging exams.
Our change in policy is guided by evidence-based research and is based on the recommendations of trusted medical societies, which have shown that shielding provides negligible, or no benefit to patient health. In some cases, the use of shields can cause the patient harm or make imaging less accurate.
In order to provide the highest diagnostic quality at the lowest health risk, we no longer place lead shields over patients during their x-ray exams.
Discontinuation of patient shields is supported by safety experts in radiation safety and radiology:
- Shielding can obscure the intended imaging field, leading to an unusable X-ray or CT scan.
- Our imaging technology automatically determines the amount of radiation required to capture a successful image. The presence of a shield can cause the machine to increase the x-ray output which exposes the patient to unnecessary increased radiation.
- The accuracy of our technology is able to isolate the radiation to the specific part of your body that is being imaged. Negligible radiation exposure scatters outside of the beam.
- Over 50 years of research has shown that radiation levels used in modern x-ray exams have no hereditary effects (i.e., mutations in the reproductive system)
Our goal is to keep you safe, comfortable and obtain the highest-quality image possible. You are encouraged to speak with your provider to discuss the benefits of this practice and any concerns that you may have.
Why the change in radiology shielding guidelines?
Current research has indicated that these shields are no longer necessary for routine use during diagnostic imaging for the following reasons:
- The amount of radiation exposure that the gonads receive during routine diagnostic imaging is well below the threshold that would adversely affect fertility. This is true for direct exposure (such as a pelvic radiograph) or indirect exposure (such as scatter radiation from imaging a different body part).
- The amount of radiation that a patient is exposed to is determined by the X-ray machine -based on the patient’s size (automatic exposure control). If the lead shield is detected by the X-ray machine, this may lead to an increased radiation exposure to the patient as the machine attempts to image through the shield.
- Shielding can obscure the imaging field, leading to an unusable X-ray or CT scan, which may lead to an incomplete interpretation, or it may lead to repeat imaging and increased radiation exposure.
How can patients rest assured they won’t be exposed to unnecessary radiation?
ALARA (As Low as Reasonably Achievable) is the concept that we should image using the least amount of radiation exposure that is necessary. In the past, lead shielding was one of the critical components of ALARA. With improvements in technology (automatic exposure control), we have been able to lower the necessary radiation exposure while maintaining high-quality imaging.
Considering that, the shields may actually increase radiation exposure because of the automatic exposure control. A shield may also block the imaging area of interest which would require a repeat X-ray and more radiation exposure. These potential issues violate the basic principles of ALARA.
Can patients coming in for an X-ray still be offered a shield if requested?
Yes. If a patient requests a shield, we will still offer a shield. The imaging technologist or physician will position the shield so that the shield will not be included in the radiograph (if possible) and will not block the imaging of the area of interest. There are some instances when a shield cannot be used because it will block the area of interest.
How has COVID affected the need to stop shielding?
Since shields are reusable, the shields need to be sanitized in between patients. With COVID-19, the concept of sanitizing equipment has become even more of an issue. If our goal is to reduce potential patient exposure to COVID-19, then the elimination of reusable lead shields is one good method to accomplish this goal. In addition to the other research-based evidence, we are using to recommend against shielding.
Further reading on updated screening guidelines: