Since the 1950s, lead shielding has been utilized to protect patients from the radiation used in many imaging procedures. This practice is no longer supported by the leading associations focused on radiation regulations. Our mission to deliver the highest quality care to our patients requires a commitment to adaptability when it means patients could be presented with better outcomes and treatments.

Effective July 1, 2022, UI Health Care will no longer utilize lead shields as radiation shielding for fetal and gonadal protection. Stephen Graves, PhD, an assistant professor within the Carver College of Medicine’s Department of Radiology, helped explain why not making the change means a greater risk for the health of patients. Measurement Of Radioactivity By

“Since the 1950s, two important things have happened when it comes to our understanding of radiation shielding. The first of which is that the radiation sensitivity of fetal and gonadal tissue is now known to be much less than originally thought. Heritable effects of radiation have actually never been demonstrated in humans, even among relatively highly exposed populations like atomic bomb survivors. And the second major thing that’s happened is that the radiation dose from imaging procedures has been reduced by roughly 20 to 25 times in the time since the 1950s. A chest x-ray now, for example, delivers similar radiation dose to what one would receive from a transatlantic flight, or even just natural background radiation in about 10 days in the state of Iowa.”

“We’re changing our policy regarding fetal and gonadal shielding in response to recent professional and radiation safety recommendations at the national and the international levels. These recommendations suggest that radiology practices should discontinue the use of fetal and gonadal shielding in routine diagnostic imaging procedures. And these recommendations are based on the fact that the shielding has been shown to provide no or negligible benefit under ideal conditions and can actually be detrimental in some situations.”

“The risk of negative health effects from diagnostic radiation is very, very low. And these imaging procedures are only performed in medical situations where the diagnostic information is important for medical care for individuals. So, if an imaging procedure is needed, the health risks are much greater if one does not receive that diagnostic care.”

“Shielding is not recommended for pregnant patients at this time, because the radiation exposure to the fetus is very low for a number of imaging procedures. Also, the exposure is well below the thresholds for negative health effects to either the mother or the fetus. Additionally, the scatter radiation that does make it to the fetus is mostly internal and an external lead apron isn’t very effective at preventing that. If the lead apron obscures a portion of the body that the radiologist needs to see during that imaging procedure, there is a chance that the procedure will need to be repeated thus resulting in even more radiation exposure for the patient.”

“This change will be both for adults and for kids undergoing diagnostic imaging procedures.”

“UI Health Care has some of the most advanced imaging technology in the world, which enables us to perform imaging procedures with as little radiation dose as possible. The detectors we use for imaging are now much more sensitive than they have been historically, which means that we can use less radiation to do the procedure. We have advanced features like automated exposure control that customize the amount of radiation to a patient’s individual anatomy, so that you’re not giving too much or too little in any individual case.

“Soon, the University of Iowa will be one of the first centers in the world with a technology called Photon counting CT, which has the potential to further reduce radiation dose for imaging procedures. Additionally, our physicians utilize their best professional judgment to make sure that we are performing these studies in patients that really need the studies. And that’s another important way to reduce unnecessary exposure.”

“Yes. In some rare cases, the lead shield can interfere with the automated exposure control of a system, thereby forcing it to increase the radiation dose during the examination procedure. It doesn’t necessarily compromise the value of that particular diagnostic procedure, but across many patients, it can have the opposite of what was intended with the lead shielding. Again, if the shielding blocks a portion of the body that the radiologist needs to see, the procedure may need to be repeated.”

“If the patient’s not willing to undergo the diagnostic procedure without fetal or gonadal shielding, the technologist can use shielding in those circumstances. But this should only happen after an informed conversation between the provider and the patient about the risks and benefits of having that shielding used.”

“Adequate shielding for our technologists and other occupational workers that work with and around x-ray technologies is still very important to reduce unnecessary exposure to these occupational workers. Keep in mind that these individuals perform many, many procedures each year. They experience only minimal exposure for each procedure, but overall, it’s still important to keep exposure levels as low as reasonably achievable. Lead aprons and thyroid shields are very effective for blocking scattered radiation, and they will remain useful tools for our team.”

“Many other health care organizations in the United States have implemented this change already based on consensus among health physics and radiation safety organizations. Other institutions will adopt these policies as they’re able.

“We have a leading radiologic technology training program in the state and the technologists that graduate from our program end up serving the health care needs of the entire state. And so, these changes will impact our training and curriculum for future graduates.

“Over time, practices in the state are likely going to follow our lead on this.”

Questions or concerns? Contact Stephen Graves at stephen-graves@uiowa.edu.

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