Related Experiment Video
Updated: Jan 8, 2026
X-ray Dose Reduction through Adaptive Exposure in Fluoroscopic Imaging
Published on: September 11, 2011
From Evidence to Practice: Implementation and Evaluation of the Discontinuation of Patient Contact Shielding in
Elaine Ryan1,2, Kerrie Norynberg2, Patricia Connor2,3
1Biomedical Technology Services, Queensland Health, Queensland, Australia.
Insights
Paediatric radiography no longer requires patient contact shielding. Implementing this change using the COM-B model and TDF was effective, with minimal patient and family concern, contrary to expectations.
Area of Science:
- Radiological protection
- Medical imaging practice
- Behavioural science in healthcare
Background:
- Patient contact shielding in paediatric radiography is a long-standing practice.
- Current evidence does not support routine use of shielding in paediatric imaging.
- An Australian quaternary paediatric hospital aimed to discontinue shielding.
Purpose of the Study:
- To evaluate the implementation of discontinuing patient contact shielding in paediatric radiography.
- To assess patient, family, and staff responses to the policy change.
- To determine the effectiveness of theory-guided implementation strategies.
Main Methods:
- A mixed-methods approach was employed, combining retrospective imaging record analysis and prospective survey data.
- Implementation strategies were informed by the capability, opportunity, motivation and behaviour (COM-B) model and theoretical domains framework (TDF).
- Data were collected over 7 months pre- and post-implementation.
Main Results:
- Shielding rates decreased significantly post-implementation (from 45% male, 39% female to near zero).
- Out of 7581 patients surveyed, only 0.4% raised queries about the policy change.
- Shielding requests dropped to zero within 5 months of implementation.
Conclusions:
- Theory-guided implementation effectively translated evidence into practice for discontinuing patient shielding.
- The removal of shielding was achieved with minimal patient and family concern.
- The study demonstrated successful practice change in paediatric radiography.
Introduction:
Patient contact shielding has been used in paediatric radiography as standard practice for decades. Contemporary evidence no longer supports its use in routine clinical practice. The Medical Imaging Department of an Australian quaternary paediatric hospital implemented the discontinuation of all patient contact shielding using the capability, opportunity, motivation and behaviour (COM-B) model and the theoretical domains framework (TDF). This study evaluated the implementation process with particular focus on patient, family and staff responses.
Methods:
An implementation study was conducted using a mixed-methods approach, comprising retrospective analysis of imaging records (7 months pre/post implementation) and prospective collection of survey data. Implementation strategies were developed using theory-guided frameworks to address potential barriers to change.
Results:
Retrospectively, there were 1614 examinations assessed pre-implementation and 1845 post-implementation. Pre-implementation shielding rates were 45% and 39% for male and female patients respectively. The post-implementation prospective survey component included 7581 patients, 0.4% (n = 31) of whom raised queries about the policy change. Only 11 shielding requests occurred within 5 months post-implementation, declining to zero thereafter.
Conclusion:
Theory-guided implementation was remarkably effective in translating contemporary evidence into practice. The process of removing patient shielding was achieved with minimal concern from patients and their families, contrary to expectations that this change would generate significant resistance.
Related Concept Videos
01:13Radiological Investigation III: Pulmonary Angiogram and PET Scan
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
01:30Radiological Investigation I: X-ray and CT
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...
01:25Transmission-based Precautions II: Airborne and Protective Environment
Airborne precautions:
Use airborne precautions when treating patients known or suspected to have diseases that spread through the air—for example, tuberculosis or measles. These organisms are present in smaller droplets expelled by an infected person and...
01:24X-ray Imaging
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion