Lead-rubber shielding effect on radiation dose to the gonads from a bilateral hand X-ray examination

Journal article


Welborn, D, and Lockwood, P. 2022. Lead-rubber shielding effect on radiation dose to the gonads from a bilateral hand X-ray examination. Radiography. https://doi.org/0.1016/j.radi.2021.12.013
AuthorsWelborn, D, and Lockwood, P.
Abstract

Introduction
Recent guidance from the British Institute of Radiology (BIR) and the American Association of Physicists in Medicine (AAPM) focuses on cessation of patient Lead-rubber (Pb) shielding placed within the Field of View (FOV) that may influence image exposure or quality. Furthermore, the BIR assert shielding organs greater than 5 cm from the primary X-ray beam will have a negligible effect to the received radiation dose. Bilateral hand X-rays are frequently and repeatedly requested for the diagnosis and ongoing management of arthritic conditions. There is a lack of literature regarding the effect of Pb shielding during bilateral hand X-ray examinations. This research aimed to investigate the scattered secondary radiation dose to the gonads during a bilateral hand X-ray, with and without the use of Pb shielding outside the FOV at a greater distance than 5 cm from the primary beam.

Methods
Using an anthropomorphic phantom and constructed upper limbs, radiation was recorded to the male and female gonads. Thermoluminescent dosimeters (TLD's) (⅛" x ⅛" x 0.15″ TLD-100H) were placed in groups of three upon the testes and within the left and right ovary to record the ionising radiation dose. Three collimated exposures were completed using a standard clinical practice hand X-ray protocol of 60 kVp and 2.5 mAs with a source to image distance (SID) of 100 cm. The mean and standard deviation of the radiation dose was calculated for both with and without Pb shielding. A paired two-sample t-test was conducted to determine statistical significance (p ≤ 0.05).

Results
Data analysis demonstrated dose measured to the testes of 5.3 μGy (SD 0.8) without Pb shielding and 2.3 μGy (SD 0.2) with Pb (reduction of 3 μGy; 56.6%). Left ovary doses measured 40.6 μGy (SD 1.2) without Pb shielding and 28.8 μGy (SD 1.7) with Pb (reduction of 11.9 μGy; 29.2%) and right ovary doses measured 39.5 μGy (SD 1.9) without Pb shielding and 26.6 μGy (SD 1.0) with Pb (reduction of 12.8 μGy; 32.4%). The paired two-sample t-test presented a statistically significant dose reduction (p = 0.0039).

Conclusion
The study demonstrated dose limitation from scattered secondary radiation to the gonads when Pb shielding was used during a bilateral hand X-ray at distances greater than 5 cm from the primary X-ray beam on anatomy outside the FOV.

Implications for practice
The use of Pb shielding over the gonad area during a bilateral hand X-ray examination aligns to ALARP best practice and provides prospects for patient (male and female) dose reduction.

KeywordsGeneral radiography ; Radiation protection; Gonads ; Scatter radiation; Lead contact shielding
Year2022
JournalRadiography
PublisherElsevier
ISSN1078-8174
Digital Object Identifier (DOI)https://doi.org/0.1016/j.radi.2021.12.013
Official URLhttps://www.radiographyonline.com/article/S1078-8174(21)00213-3/fulltext
Publication dates
Online06 Jan 2022
Publication process dates
Accepted22 Dec 2021
Deposited10 Jan 2022
Accepted author manuscript
License
File Access Level
Open
Output statusPublished
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