Effectiveness of abdominal shields in chest radiography: a Monte Carlo evaluation

Attitudes and awareness regarding the European consensus statement on the use of patient contact shielding

INTRODUCTION

Lead contact shielding has been an essential element of patient radiation protection since its introduction in the early 1900s. The European Consensus Statement (ECS) on Patient Contact Shielding argues that diagnostic radiation doses have decreased to negligible levels. Given the potential for lead shielding to be misaligned or displaced, the ECS recommends refraining from its use to prevent the occurrence of repeated radiation exposures. This study aims to describe the awareness of radiographers concerning the European Consensus Statement with emphasis dedicated to shielding outside the FOV or out-of-field shielding (OFS).

METHODS

An online survey was designed to assess radiographer's awareness and attitudes to the ECS. This survey incorporated quantitative and qualitative elements. The survey was distributed to a target population of registered radiographers.

RESULTS

There were 112 participants who registered as Irish radiographers. Seventy-nine (71 %) participants knew of the European Consensus publication on patient contact shielding. Eighty-one (72.3 %) participants agreed that the risk from ionising radiation in general radiography exams is negligible. Seventy-two (63.4 %) participants felt more training should be provided on OFS. Thirty-two (28.6 %) participants agreed that some patients are more sensitive to ionising radiation, and shielding may be the safest action.

CONCLUSION

The results of this study indicate that responding radiographers are aware of the European Consensus Statement and largely agree with its recommendations to discontinue the use of shielding during low-dose X-ray examinations. Additionally, the study reveals that most radiographers do not employ lead shielding in various common clinical practice scenarios.

IMPLICATIONS FOR PRACTICE

Further investigation is required to evaluate radiographer's attitudes toward contact shielding. Future research might explore the psychological impact on patients, infection concerns, departmental protocols, and discomfort related to contact shielding.

Effect of the oblique incidence of radiation beams on emerging radiation behind lead and concrete shields: a multilayer method for dose transmission calculations

Objective. For calculating shielding in x-ray rooms, it is often assumed that the beams impinge perpendicularly on the protective barriers. This is not always true, but this premise simplifies the calculations and enhances protection by being a conservative calculation. In this work, a method for calculating radiation transmission through planar shielding that considers the obliquity of the incident beam is presented.Approach. The output of the method produces energy spectra according to the direction of radiation impinging on the shielding. Four angles of incidence on the barrier are considered, along with monoenergetic pencil beams with energies ranging from 10 to 150 keV and two materials: lead and concrete. The direction of emerging photons is discretized into 49 different direction vectors. Monte Carlo calculations are performed for thicknesses of 0.1, 0.5, and 1.0 mm of lead, and 1, 5, 10, and 15 cm of concrete. Additionally, a multilayer iterative method is implemented for calculating attenuation of other thicknesses.Main results. The distribution of radiant energy according to the coordinates of its directional vector illustrates the effect of the obliquity of the incidence and the significance of the shielding material employed. In the case of concrete, the dispersion of radiation away from the original direction of incidence is much more pronounced than in the case of lead at energies below its K-edge. The multilayer iterative method provides highly accurate values of transmitted radiant energy in both monoenergetic and polyenergetic beams, for both lead and concrete, across the various studied incidence directions.Significance. Considering the direction of the photons reaching a shield and the direction of the photons passing through it allows multilayer composite shielding calculations to closely approximate the calculation made for the composite shielding.

The effect of breast shielding outside the field of view on breast entrance surface dose in axial X-ray examinations: a phantom study

PURPOSE

The purpose of this study was to evaluate the effect of outside-field-of-view (FOV) lead shielding on the entrance surface dose (ESD) of the breast on an anthropomorphic X-ray phantom for a variety of axial skeleton X-ray examinations.

METHODS

Using an anthropomorphic phantom and radiation dosimeter, the ESD of the breast was measured with and without outside-FOV shielding in anterior-posterior (AP) abdomen, AP cervical spine, occipitomental 30° (OM30) facial bones, AP lumbar spine, and lateral lumbar spine radiography. The effect of several exposure parameters, including a low milliampere-seconds technique, grid use, automatic exposure control use, wraparound lead (WAL) use, trolley use, and X-ray table use, on the ESD of the breast with and without outside-FOV shielding was investigated. The mean ESD (μSv) and standard deviation for each radiographic protocol were calculated. A one-tailed Student's t-test was carried out to evaluate whether ESD to the breast was reduced with the use of outside-FOV shielding.

RESULTS

A total of 920 breast ESD measurements were recorded across the different protocol parameters. The largest decrease in mean ESD of the breast with outside-FOV shielding was 0.002 μSv (P = 0.084), recorded in the AP abdomen on the table with a grid, OM30 on the table with a grid, OM30 standard protocol on the trolley, and OM30 on the trolley with WAL protocols. This decrease was found to be statistically non-significant.

CONCLUSION

This study found no significant decrease in the ESD of the breast with the use of outside-FOV shielding for the AP abdomen, AP cervical spine, OM30 facial bones, AP lumbar spine, or lateral lumbar spine radiography across a range of protocols.

EFFECT OF PELVIC LEAD SHIELD ON ORGAN DOSES IN POSTERO-ANTERIOR CHEST RADIOGRAPHY

Lead shields are commonly used in X-ray imaging to protect radiosensitive organs and to minimise patient's radiation dose. However, they might also complicate or interfere with the examination, and even decrease the diagnostic value if they are positioned incorrectly. In this study, the radiation dose effect of waist half-apron lead shield was examined via Monte Carlo simulations of postero-anterior (PA) chest radiography examinations using a female anthropomorphic phantom. Relevant organs for dose determination were lungs, breasts, liver, kidneys and uterus. The organ dose reductions varied depending on shield position and organ but were negligible for properly positioned shields. The shield that had the largest effective dose reduction (9%) was partly positioned inside the field of view, which should not be done in practice. Dose reduction was practically 0% for properly positioned shields. Therefore, the use of lead shield in the pelvic region during chest PA examinations should be discontinued.

Systematic literature review on the benefit of patient protection shielding during medical X-ray imaging: Towards a discontinuation of the current practice

PURPOSE

Patient shielding during medical X-ray imaging has been increasingly criticized in the last years due to growing evidence that it often provides minimal benefit and may even compromise image quality. In Europe, and as also shown in a short assessment in Switzerland, the use of patient shielding is inhomogeneous. The aim of this study was to systematically review recent literature in order to assess benefits and appraise disadvantages related to the routine use of patient shielding.

METHODS

To evaluate benefits and disadvantages related to the application of patient shielding in radiological procedures, a systematic literature review was performed for CT, radiography, mammography and fluoroscopy-guided medical X-ray imaging. In addition, reports from medical physics societies and authorities of different countries were considered in the evaluation.

RESULTS

The literature review revealed 479 papers and reports on the topic, from which 87 qualified for closer analysis. The review considered in- and out-of-plane patient shielding as well as shielding for pregnant and pediatric patients. Dose savings and other dose and non-dose related effects of patient shielding were considered in the evaluation.

CONCLUSIONS

Although patient shielding has been used in radiological practice for many years, its use is no longer undisputed. The evaluation of the systematic literature review of recent studies and reports shows that dose savings are rather minimal while significant dose- and non-dose-related detrimental effects are present. Consequently, the routine usage of patient protection shielding in medical X-ray imaging can be safely discontinued for all modalities and patient groups.

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

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.

Assessment of the effectiveness of attenuation of Pb aprons by using TLD dosimetry and Monte Carlo calculations

We developed an experimental set-up by using a continuous emission X-ray (Pantak DXT-3000) and three types of Pb aprons, with thicknesses of 0.25, 0.5, and 0.75mm, coated with Mylar fiber on their surface. Aprons were placed at a distance of 2.5m from the focus. Aluminum filtration was performed at the beam output to reproduce the qualities of narrow beams, N40 (E_effective =33keV), N80 (E_effective =65keV), and N100 (E_effective =83keV), according to the ISO standard 4037 (1-3). Each apron was fixed with 10 thermoluminescent dosimeters (TLDs) over its surface, five dosimeters before and five dosimeters after irradiation with X-rays. Dosimeter readings were noted, and the attenuation coefficients for each effective energy were calculated. To confirm the method of effective energy of ISO-4037 and evaluate the effectiveness of aprons according to the energy range required for different medical practices, a Monte Carlo simulation using GEANT4 code was performed. Thus, the fluence and the absorbed dose in each of the dosimeters were determined, and then the coefficients of linear attenuation were calculated and compared with the experimental data and with those reported by the National Institute of Standards and Technology. Results were consistent between theoretical calculations and experimental measures. This work will serve to make assessments for other personalized radiation protectors made of Pb.