By: Lauren McRae

Take a moment and think back to the last time you had an X-ray. You may remember the radiologic technologist placing a lead apron (shield) over part of your body to protect it from radiation. It’s now an outdated practice: The American Association of Physicists in Medicine and the American College of Radiology no longer supports shielding patients’ reproductive organs and fetuses during imaging studies that use radiation, such as X-rays and CT scans, according to new findings.

NorthShore is adjusting our policy based on the most recent research. Other health providers across the nation (including those in the Chicagoland area) are adopting this new policy as well.

Christopher Kay, M.D., Diagnostic Radiology, Pediatric Radiology, discusses the change to this decades-long policy:

What is research now telling us about shielding?
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 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.

Why were lead aprons/traditional shielding used in the past?
it was believed that it was necessary to protect the reproductive organs from radiation. New studies have shown that it does not offer significant protection, but in fact, could lead to inaccurate imaging results.

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.

As we discussed earlier, 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.

What do you tell patients when they inquire about the change in procedure?
When a patient questions me about shielding, I provide open and honest answers regarding shielding. I explain the shield may block my ability to see an area of interest and force me to perform more imaging than may have been necessary. I also explain that I will only be imaging the area of interest. I will not unnecessarily include the gonadal regions or other radiation-sensitive areas. Finally, I explain that the imaging technology has improved to provide high-quality imaging with lower radiation exposure to the patient.

Can patients who come 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.

Will the providers/technicians still wear shields? If so, why?
Yes, the providers and technologists will still wear shields. Since these healthcare workers are exposed to radiation from imaging every day, these shields protect them from this daily exposure.

If a person has multiple back-to-back X-rays, will and can a shield help?
There is no real benefit from shielding even when a patient is receiving multiple imaging examinations. The amount of radiation from an imaging examination is well below the threshold that would adversely affect fertility or cause other issues.

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.

Anything you would like to add?
Here at NorthShore, patient safety is one of our primary goals. We have taken time to consider our new shielding policy, and our patients can rest assured that our policy is based on the current scientific research and is based on the recommendations of medical societies.