Answer to Question #12892 Submitted to "Ask the Experts"

Category: Medical and Dental Patient Issues — Pediatric Issues

The following question was answered by an expert in the appropriate field:

Q

What are the risks my son faces if gonadal shielding was inadequate during an upper gastrointestinal (UGI) x ray as a newborn in 2005? Infertility? Cancer? Growth problems? Delayed puberty? I moved the shielding when the technologist was out of the room in an attempt to make sure it was in the right place. I have always worried I may not have put the shield back correctly. 

A

Your son faces absolutely no risks from the UGI x ray. Growth, fertility, and onset of puberty, would not be affected. At the level of radiation dose from a UGI there would be no discernable increase in the chances of developing cancer.  

When taking an x-ray exam, the size of the x-ray field of view is limited to the area of interest. In a UGI examination there would be no reason to include the gonads in the x-ray image, so the x-ray field of view would exclude the pelvis and gonads. Even if there was no gonadal shielding, there would be no effect. Although, gonadal shields have been used in these circumstances, the use of the shielding really does not reduce the radiation dose to the gonads. In the image below, the red lines indicate the x rays coming from the x-ray machine, the pink line represents the x rays heading towards the gonads, and the blue line is the lead apron. As you can see, the apron does not intercept any x rays. Only a very small fraction of the x rays would change directions (scatter) towards the gonads, and most of these would be absorbed by other tissues in the body (even in a newborn infant).  



On 2 April 2019, the American Association of Physicists in Medicine (AAPM) released a new position statement, "The Use of Patient Gonadal and Fetal Shielding." The AAPM says:

"Patient gonadal and fetal shielding during x-ray based diagnostic imaging should be discontinued as routine practice. Patient shielding may jeopardize the benefits of undergoing radiological imaging. Use of these shields during x ray based diagnostic imaging may obscure anatomic information or interfere with the automatic exposure control of the imaging system. These effects can compromise the diagnostic efficacy of the exam, or actually result in an increase in the patient's radiation dose. Because of these risks and the minimal to nonexistent benefit associated with fetal and gonadal shielding, AAPM recommends that the use of such shielding should be discontinued."

The position statement then goes on to explain the rationale behind the recommendation.  

Kent Lambert, CHP, FHPS

Ask the Experts is posting answers using only SI (the International System of Units) in accordance with international practice. To convert these to traditional units we have prepared a conversion table. You can also view a diagram to help put the radiation information presented in this question and answer in perspective. Explanations of radiation terms can be found here.
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