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The use of gonad shielding in paediatric hip and pelvis radiographs
1Addenbrooke's Hospital, University of Cambridge Teaching Hospitals NHS Foundation Trust, UK. sjfawcett@doctors.org.uk
Insights
Gonad shields are crucial for protecting children during hip and pelvis X-rays, but placement accuracy is alarmingly low. This study highlights the need for improved guidelines and training to ensure effective radiation protection for pediatric patients.
Area of Science:
- Pediatric Radiology
- Radiation Protection
- Medical Imaging Audit
Background:
- Inaccurate gonad shield placement in pediatric radiography is a persistent national and international concern.
- Previous studies have identified issues with gonad shield utilization and accuracy in children's X-rays.
Purpose of the Study:
- To review the literature on gonad shielding in pediatric radiography.
- To conduct a regional audit assessing the use and accuracy of gonad shield placement for pediatric hip and pelvis radiographs.
Main Methods:
- A review of 2405 anteroposterior hip or pelvis radiographs from 9 centers, involving patients under 16 years old.
- Assessment of shield presence, accuracy of placement for gonad protection, and visualization of orthopedic landmarks.
- Inclusion of recent and all previously available relevant radiographs.
Main Results:
- Gonad shields were used in only 70% of indicated cases for pediatric pelvis radiographs.
- Accurate shield placement was observed in only 38% of all shields used and 26% of cases where shielding was indicated.
- Formal departmental guidelines for shield use were present in only two of the nine participating centers.
Conclusions:
- Effective gonad protection for children undergoing hip and pelvis radiography is suboptimal.
- There is a critical need for clear departmental guidelines, shield redesign, enhanced training, and regular audits.
- Implementing these measures is essential to improve the accuracy and effectiveness of gonad shielding in pediatric patients.
Abstract:
The problem of inaccurate placement of gonad shields in children has been highlighted by several publications nationally and internationally over the past decade and more. Here, we review the literature and present the results of a regional audit designed to assess the use and accuracy of placement of gonad shields for hip and pelvis radiographs in children. 100 consecutive anteroposterior hip or pelvis radiographs in patients under the age of 16 years were reviewed in each of 9 centres. We also included the most recent and all previously available relevant radiographs. A total of 2405 radiographs were reviewed with regard to the presence of a shield and to the accuracy of any shield placement with respect to gonad protection and visualization of orthopaedic landmarks. It is recommended that gonad shields are used in all follow-up paediatric pelvis radiographs. Our results show they were only used in 70% of such cases. When placed, only 38% of all shields were considered to be positioned accurately. For cases where shielding was indicated, an accurately placed shield was present in just 26% of radiographs. Formal written departmental guidelines for shield use were only available in two centres. We conclude that clear guidelines need to be formulated which, together with shield redesign, improved training and audit, should increase effective gonad protection for children.
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