Patient Shielding in Diagnostic Imaging: Discontinuing a Legacy Practice

Quantitative Changes in Breast Density and Mammographic Features Induced by Pregnancy and Lactation: A Longitudinal Study

OBJECTIVE

Quantitative changes in mammographic properties during pregnancy and lactation remain underexplored. Therefore, the purpose of this study was to quantify mammographic changes in the breast from prepregnancy through lactation to postweaning at the individual level.

METHODS

Mammograms of 39 women at elevated risk (mean age 38.7 years) who underwent 3 sequential examinations spanning the lactation period were retrospectively analyzed. Volpara-derived mammographic properties, including breast volume, fibroglandular tissue volume, volumetric breast density, compression force, and radiation dose, were automatically extracted and were statistically compared between the periods.

RESULTS

Significant longitudinal changes in breast tissue were observed. During lactation, breast volume increased by 45%, fibroglandular tissue volume increased by 138.5%, and volumetric breast density increased by 53.2% compared with prepregnancy levels (P <.001 for all). After weaning, these values decreased by 23.3%, 52.8%, and 27.3%, respectively, compared with lactation (P <.001 for all). Breast compression was decreased by 22.3% on average during lactation compared with prepregnancy (P <.001), while it was not different between lactation and postweaning (P = .11). The radiation dose during lactation increased by 20% compared with both prepregnancy (P = .004) and postweaning (P = .005).

CONCLUSION

The temporal changes in mammographic properties from prepregnancy to lactation include significant increases in breast volume, fibroglandular tissue volume, breast density, and radiation dose, along with a decrease in compression force. While these changes reverse from lactation to postweaning, they generally do not return to prepregnancy levels.

Let's talk about radiation dose and radiation protection in children

Children are more sensitive to ionizing radiation than adults. Even though the risk is very low, exposure from radiological examinations can possibly cause them long-term side effects. Recent large epidemiological studies involving children and young adults have added evidence suggesting that even small doses of radiation, such as those from computed tomography scans, might slightly increase the risk of developing cancer later in life. Therefore, even though radiologic studies are essential for an accurate diagnosis and management of various conditions, it is crucial to minimize radiation exposure. This article addresses radiation protection for children in the medical use of ionizing radiation and it is set in the context of the European legislative framework regarding radiation protection. It advocates for a holistic approach to paediatric radiological tests. This approach includes the key principles of radiation protection, such as the justification of imaging procedures supported by referral guidelines, as well as the optimization of techniques (according to the ALARA principle) and effective communication with parents about the benefits and the risks of radiologic procedures. Protecting children from unnecessary radiation is not only a technical challenge, but also a moral obligation and a legal requirement.

Patient Shielding in Ultra-High-Resolution Cone-Beam CT of the Upper Extremity with a Twin Robotic X-Ray System

Background/Objectives: Gantry-free cone-beam CT (CBCT) allows for ultra-high-resolution (UHR) upper extremity imaging in a comfortable tableside position. The aim of this study was to assess the organ-specific radiation burden and the effect of dedicated lead shielding in the UHR-CBCT of the wrist and elbow. Methods: A modified Alderson-Rando phantom was scanned with the tableside UHR-CBCT mode of a twin robotic X-ray system employing identical scan parameters for wrist and elbow imaging. An ion chamber was used in conjunction with an electrometer to obtain representative organ dose measurements for the eye lens, thyroid gland, breast tissue, and abdomen. All measurements were performed with and without lead shielding. Results: Irrespective of the examined upper extremity joint, the highest absorbed dose among the assessed organs was determined for the eye lens (wrist imaging: 0.10 ± 0.01 mGy, elbow imaging: 0.12 ± 0.01 mGy). The most effective organ dose reduction by means of shielding in wrist CBCT was achieved for the thyroid gland (-17%). In elbow CBCT, the abdomen (-48%) and the ipsilateral breast (-39%) benefited particularly from shield protection. Conclusions: Although shielding was more effective in elbow than wrist scans, the overall impact in terms of absolute dose reduction was marginal.

CAR/CETARS/CSAR Practice Guideline on Imaging the Adult Patient With Right Lower Quadrant Pain

In 2023, the Canadian Society of Abdominal Radiology (CSAR) and Canadian Emergency, Trauma, and Acute Care Radiology Society (CETARS) received Canadian Association of Radiologists (CAR) member feedback that there was an unmet educational need for guidance in the imaging investigation of right lower quadrant (RLQ) pain. Members requested specific guidance on how to handle controversial scenarios including which test to order when, specifics of imaging protocols, and managing pregnant patients who have RLQ pain-all from a Canadian perspective. After conducting an exhaustive literature review, the working group agreed that a Canadian-specific set of guidelines was warranted. The management recommendations presented in this guideline were discussed as a group to achieve expert consensus. As the workup for RLQ pain can vary considerably in the paediatric population, the scope of this paper was restricted to adults (18 years of age or older). Whenever possible, the best evidence was used to inform the clinical guidance, and where gaps existed, the guidelines reflect consensus among experts in the field. The result is a framework to aid in this process of managing patients with RLQ pain across various clinical scenarios while addressing current questions and controversies, particularly those most relevant to the Canadian healthcare system.

Simulation of the shielding effect of lead apron undergoing chest CT scan

Lead aprons are used to reduce radiation dose to patients. As the distance between the lead apron and the edge of the scan range increases, organ dose is expected to decrease, but with increasing scattered radiation dose in the body. By simulation, this work aims at estimate whether the organ dose increases due to the scattered radiation in the body with lead apron. A standard-sized male and a female phantom is used to simulate organ doses of chest scans in various lead apron shielding situations. Simulations in this work considered different distance between the edge of the 0.35-mm lead apron and the edge of the scan range. For the female phantom, the dose to the gonads was significantly reduced (56% on average), but not as much as men (78% on average). However, the amount of dose reduction is small for male and female phantoms (0.0082 mGy/100 mAs and 0.0160 mGy/100 mAs).

CETARS/CAR Practice Guideline on Imaging the Pregnant Trauma Patient

Imaging of pregnant patients who sustained trauma often causes fear and confusion among patients, their families, and health care professionals regarding the potential for detrimental effects from radiation exposure to the fetus. Unnecessary delays or potentially harmful avoidance of the justified imaging studies may result from this understandable anxiety. This guideline was developed by the Canadian Emergency, Trauma and Acute Care Radiology Society (CETARS) and the Canadian Association of Radiologists (CAR) Working Group on Imaging the Pregnant Trauma Patient, informed by a literature review as well as multidisciplinary expert panel opinions and discussions. The working group included academic subspecialty radiologists, a trauma team leader, an emergency physician, and an obstetriciangynaecologist/maternal fetal medicine specialist, who were brought together to provide updated, evidence-based recommendations for the imaging of pregnant trauma patients, including patient safety aspects (eg, radiation and contrast concerns) and counselling, initial imaging in maternal trauma, specific considerations for the use of fluoroscopy, angiography, and magnetic resonance imaging. The guideline strives to achieve clarity and prevent added anxiety in an already stressful situation of injury to a pregnant patient, who should not be imaged differently.

Radiation safety of dentomaxillofacial radiology in Finland: Reported abnormal irradiation-related incidents during 2012-2022

INTRODUCTION

This study evaluates adverse events (AEs) in dentomaxillofacial radiology (DMFR) in Finland, including their quantity, nature, and outcomes. It also compares reporting activity between public and private healthcare organizations, as they share same legal obligations to report AEs. Two-thirds of dental images are taken in public, the rest in private healthcare.

METHODS

In Finland, radiation-related AEs are reported to the Radiation and Nuclear Safety Authority (STUK). We categorized DMFR-related AEs by nature, outcome, and imaging modality. We also submitted a questionnaire to STUK to gather information on their observations and remarks made during inspections of establishments providing dental imaging services.

RESULTS

During 2012-2022, STUK received reports of 1343 DMFR-related AEs, mostly causing patient harm (92.9%) leading almost always to excessive radiation doses (99.7%). Private healthcare reported most AEs (65.2%), with municipal institutions reporting the remainder (34.8%). Intraoral-related AEs (20.0%) slightly outnumbered panoramic-related ones (18.7%), but the majority (56.7%) didn't specify the imaging modality. CBCT-related incidents were least reported (4.5%). During STUK's inspections, remarks mostly concerned deficiencies in practical quality assurance (31.3%) or technical quality assurance (32.9%).

CONCLUSION

DMFR-related AEs may be underreported despite legal obligations, with most stemming from human error, highlighting the need to enhance patient safety culture. There's a notable reporting gap between private and public healthcare providers relative to the number of dental radiographs conducted. Organizational deficiencies in practical and technical quality assurance underscore the importance of ongoing education, as well as monitoring by STUK.

IMPLICATIONS FOR PRACTICE

Enhancing patient safety culture in dentistry, including dentomaxillofacial radiology, demands customized multiprofessional development, as unaltered patient safety procedures from medicine and secondary care may not align with dentistry's requirements.

Factors affecting radiographers' use of dose-reduction measures

This study investigates radiographers' views on implementing dose-reduction measures, with a focus on verifying patient identity and pregnancy status, practising gonad shielding in men and using compression. An electronic questionnaire was distributed to radiographers working in general radiography and/or computed tomography. The questionnaire was based on factors from a framework for analysing risk and safety in clinical medicine. Ordered logistic regressions were used to analyse associations among factors and use of dose-reduction measures. In total, 466 questionnaires were distributed and 170 radiographers (36%) completed them. Clear instructions and routines, support from colleagues, knowledge and experience, a strong safety culture, managerial support and access to proper equipment influence the likelihood of using dose-reduction measures. The strongest associations were found between support from colleagues and verifying pregnancy status (OR = 5.65,P= 0.026), safety culture and use of gonad shielding (OR = 2.36,P= 0.042), and having enough time and use of compression (OR = 2.11,P= 0.003). A strong safety culture and a supportive work environment appears to be essential for the use of dose-reduction measures, and education, training and stress management can improve utilisation of dose-reduction measures.

Radiographers' perceptions on the quality of managing general radiographic paediatric examinations through the use of a reflective tool

INTRODUCTION

Paediatric patients are a vulnerable population that require additional care by healthcare professionals. Quality managing these examinations ensures that effective and quality care is provided to individual patients, whilst encouraging consistency within the medical imaging department. This study explored radiographers' perspectives on quality management strategies of general radiographic paediatric examinations using a paediatric imaging reflective checklist.

METHODS

A quantitative descriptive research design with qualitative questions was used through a purposive sampling method from both public and private Australian diagnostic imaging qualified radiographers who had experience in paediatric imaging examinations. The paediatric imaging service reflective tool consisted of 65 items in total. Data analysis entailed Microsoft Excel version 16.16.6 and Jamovi version 2.3.21 for the closed-ended questions and for the open-ended responses a thematic analysis.

RESULTS

The participation rate was 13.2% and the most significant findings were: lead shielding was still being used at their organisation, despite recent recommendations to suspend its use; access to paediatric patient related information resources is limited; there was no involvement of families and communities regarding policy development or quality improvement measures as advocated in literature; and there was a need for enhanced specialised paediatric education, training and protocols.

CONCLUSION

Using the paediatric patient-centred imaging reflective checklist, radiographers had an opportunity to identify quality improvement indicators as well as issues that could further enhance best practice principles. Further studies could inform on the validity of this reflective tool.

The effect of contact radiation shielding on breast dose during CT abdomen-pelvis: a phantom study

This study aims to investigate if contact shielding reduces breast radiation dose during computed tomography (CT) abdomen-pelvis examinations using automatic tube current modulation to protect one of the four most radiosensitive organs during CT examinations. Dose measurements were taken with and without contact shielding across the anterior and lateral aspects of the breasts and with and without organ dose modulation (ODM) to quantify achievable dose reductions. Although there are no statistically significant findings, when comparing with and without shielding, the mean breast surface dose was reduced by 0.01 μSv without ODM (1.92-1.91 μSv, p = 0.49) and increased by 0.03 μSv with ODM (1.53-1.56 μSv, p = 0.44). Comparing with and without ODM, the mean breast surface dose was reduced by 0.35 μSv with shielding (1.91-1.56 μSv, p = 0.24) and by 0.39 μSv without shielding (1.92-1.53 μSv, p = 0.17). The addition of contact shielding does not provide significant breast surface radiation dose reduction during CT abdomen-pelvis.

How useful is pre-referral pediatric spine imaging?

PURPOSE

Primary care physicians rely on radiology reports to confirm a scoliosis diagnosis and inform the need for spine specialist referral. In turn, spine specialists use these reports for triage decisions and planning of care. The objectives were to determine (1) the adequacy of index images to inform treatment decisions at the initial consultation and (2) the utility of index radiology reports for appropriate triage decisions.

METHODS

A retrospective chart review was conducted including all idiopathic scoliosis patients seen for initial consultation, aged three to 18 years, between January 1 and April 30, 2021. A score out of five was generated based on the adequacy of index images to provide accurate Cobb angle measurements and determine skeletal maturity. Index images were considered inadequate if repeat imaging was necessary. Index radiology reports, associated imaging, and new imaging, if obtained at the initial consultation, were compared.

RESULTS

Of the 94 patients reviewed, 79% (n = 74) required repeat imaging at the initial consultation, of which 74% (n = 55) were due to insufficient quality and/or limited field of view. Of index images available for review at the initial consult (n = 80), 41.2% scored five out of five, and 32.5% scored two or below. Comparing index radiology reports to initial visit evaluation with ≤ 60 days between imaging (n = 49), discrepancies in Cobb angle were found in 24.5% (95% CI 14.6, 38.1) of patients. The Risser stage was reported in 14% of index radiology reports.

CONCLUSION

Although pre-referral pediatric spine radiographs serve a diagnostic purpose, most are inadequate for comprehensive idiopathic scoliosis evaluation.

LEVEL OF EVIDENCE

III.

Radiographers' attitudes toward the use of lead contact shielding

INTRODUCTION

Lead contact shielding has been a crucial component of patient radiation protection since it was first introduced in the early 1900s. Concerns surrounding the hereditary effects of ionising radiation were a driver for using lead shielding. Recently the American Association of Physics in Medicine (AAPM) and the British Institute of Radiology (BIR) have published position papers that suggest that lead contact shielding is no longer needed due to reduced radiation doses for x-ray examinations. This work examines radiographers' opinions on these position papers.

METHODS

An online survey with quantitative and qualitative elements was designed to explore knowledge and attitudes toward the BIR and AAPM position papers. The population for this survey was all qualified radiographers.

RESULTS

The majority (59%) of participants are aware of the AAPM guidance, and 76% are aware of the BIR guidance. Given the changes in the gonad tissue weighting factor, 66% believed additional emphasis should be placed on protecting organs and tissues with higher tissue weighting factors. The vast majority (87%) believed lead shielding is not the primary dose reduction strategy, with 82% agreeing that lead shielding may interfere with the AEC.

CONCLUSION

This study identifies a perception that lead protection may still play a role in patient protection, particularly for children and pregnant patients. However, it is not considered the primary mechanism of protection. More specific guidance and information are needed to incorporate the guidance for radiographers into working practice, improving patient care.

IMPLICATIONS FOR PRACTICE

Lead shielding remains a tool for radiation protection in particular examinations, however, its role has diminished in clinical practice.

RECOMMENDATIONS

Additional research is required into the number of repeat x-rays associated with the use of lead shielding and the actual dose saving for shielding outside the field of view. Additional education and specific clarification on when to use and not use lead contact shielding is required.

Exploring radiographers' perceptions and knowledge about patient lead shielding: a cross-sectional study in Greece and Cyprus

The present study aimed to explore radiographers' knowledge, clinical practice and perceptions regarding the use of patient lead shielding in Greece and Cyprus. Qualitative data were analyzed using conceptual content analysis and through the classification of findings into themes and categories. A total of 216 valid responses were received. Most respondents reported not being aware of the patient shielding recommendations issued by the American Association of Physicists in Medicine (67%) or the guidance issued by the British Institute of Radiology (69%). Shielding-related training was generally not provided by radiography departments (74%). Most of them (85%) reported that they need specific guidance on lead shielding practices. Also, 82% of the respondents said that lead shielding should continue to be used outside the pelvic area when imaging pregnant patients. Pediatric patients are the most common patient category to which lead shielding was applied. Significant gaps in relevant training have been identified among radiographers in Greece and Cyprus, highlighting the need for new protocols and provision of adequate training on lead shielding practices. Radiography departments should invest in appropriate shielding equipment and adequately train their staff.

Effectiveness of protective thyroid shield in chest X-ray imaging

Chest X-ray imaging is the most common X-ray imaging method for diagnosing coronavirus disease. The thyroid gland is one of the most radiation-sensitive organs of the body, particularly in infants and children. Therefore, it must be protected during chest X-ray imaging. Yet, because it has benefits and drawbacks, using a thyroid shield as protection during chest X-ray imaging is still up for debate.Therefore, this study aims to clarify the need for using a protective thyroid shield during chest X-ray imaging. This study was performed using different dosimeters (silica beads as a thermoluminescent dosimeter and an optically stimulated luminance dosimeter) embedded in an adult male ATOM dosimetric phantom. The phantom was irradiated using a portable X-ray machine with and without thyroid shielding. The dosimeter readings indicated that a thyroid shield reduced the radiation dose to the thyroid gland by 69% ± 18% without degrading the obtained radiograph. The use of a protective thyroid shield during chest X-ray imaging is recommended because its benefits outweigh the risks.

European survey on the use of patient contact shielding during radiological examinations

OBJECTIVES

Contact shielding (CS) of patients during X-ray studies has been used for decades to protect radiosensitive organs. This practice has not changed much despite increasing evidence that CS is not useful in many cases. The Gonad And Patient Shielding (GAPS) group-founded by representatives of the main European bodies involved in radiology-promoted this survey to assess the current practice of CS among European radiology departments and the attitude towards a non-shielding policy.

METHODS

Over a four-month period (15 May-15th September 2021) European Society of Radiology and European Society of Paediatric Radiology radiologist members were invited to respond to a web-based questionnaire consisting of 59 questions.

RESULTS

225 centres from 35 countries responded to this survey. CS was routinely applied in at least one radiological modality in 49.2% of centres performing studies in adults, 57.5% of centres performing studies in children, and 47.8% of centres performing studies on pregnant women. CS was most frequently used in conventional radiography, where the most frequently shielded organs were the gonads, followed by thyroid, female breasts, and eye lens. 83.6% respondents would follow European recommendations on the use of CS when provided by the main European bodies involved in radiology.

CONCLUSIONS

This review shows that CS is still largely used across Europe. However, a non-shielding policy could be adopted in most departments if European professional societies provided recommendations. In this regard, a strong commitment by European and national professional societies to educate and inform practitioners, patients and carers is paramount.

CLINICAL RELEVANCE STATEMENT

According to this survey expectations of patients and carers, and skepticism among professionals about the limited benefits of CS are the most important obstacles to the application of a no-shielding policy. A strong commitment from European and national professional societies to inform practitioners, patients and carers is fundamental.

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.

Trauma in Pregnancy

Trauma is the leading cause of nonobstetric maternal death. Pregnant patients have a similar spectrum of traumatic injuries with a noted increase in interpersonal violence. A structured approach to trauma evaluation and management is recommended with several guidelines expanding on ATLS principles; however, evidence is limited. Optimal management requires understanding of physiologic changes in pregnancy, a team-based approach, and preparation for interventions that may including neonatal resuscitation. The principles of trauma management are the same in pregnancy with a systematic approach and initial maternal focused resuscitation..

Evaluation of silicone rubber-lead shield's effectiveness in protecting the breast during thoracic CT

Radiation of thoracic computed tomography (CT) involves the breast although it is not considered an organ of interest. According to the International Commission on Radiological Protection (ICRP) No. 103, the breast is an organ with a high level of sensitivity when interacting with x-rays, increasing the potential risk of breast cancer. Therefore, the radiation dose must be optimized while maintaining image quality. The dose optimization can be accomplished using a radiation shield. This study aims to determine the effect of silicone rubber (SR)-lead (Pb) in various thicknesses as an alternative protective material limiting dose and preserving the image quality of the breast in thoracic CT. SR-Pb was made from SR and Pb by a simple method. The SR-Pb had thicknesses of 3, 6, 9, and 12 mm. The breast dose was measured using a CT dose profiler on the surface of the breast phantom. The CT number and the noise level of the resulting image were determined quantitatively. The dose without the radiation shield was 5.4 mGy. The doses measured using shielding with thicknesses of 3, 6, 9, and 12 mm were 5.2, 4.5, 4.3, and 3.3 mGy, respectively. Radiation shielding with a thickness of 12 mm reduced breast surface dose by up to 38%. The CT numbers and noise levels for the left and right breast phantom images were almost the same as those ​​without radiation shields indicating there were only slight artifacts in the image. Therefore, SR-Pb is considered a good shielding material which can be pplied in a clinical setting by placing it directly on the breast surface for dose optimization.

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.

Breast Shielding Combined With an Optimized Computed Tomography Pulmonary Angiography Pregnancy Protocol: A Special Use-Case for Shielding?

OBJECTIVES

To determine the impact of breast shields on breast dose and image quality when combined with a low-dose computed tomography pulmonary angiography (CTPA) protocol for pregnancy.

METHODS

A low-dose CTPA protocol, with and without breast shields, was evaluated by anthropomorphic phantom and 20 prospectively recruited pregnant participants from January to October 2019. Thermoluminescent dosimeters measured surface and absorbed breast dose in the phantom and surface breast dose in participants. The Monte-Carlo method estimated the absorbed breast dose in participants. Image quality was assessed quantitatively by regions of interest analysis and subjectively by the Likert scale. Doses and image quality for CTPA alone were compared with CTPA with breast shields.

RESULTS

Mean surface and absorbed breast dose for CTPA alone were 1.3±0.4 and 2.8±1.5 mGy in participants, and 1.5±0.7 and 1.6±0.6 mGy in the phantom. Shielding reduced surface breast dose to 0.5±0.3 and 0.7±0.2 mGy in the phantom (66%) and study participants (48%), respectively. Absorbed breast dose reduced to 0.9±0.5 mGy (46%) in the phantom.Noise increased with breast shields at lower kV settings (80 to 100 kV) in the phantom; however, in study participants there was no significant difference between shield and no-shield groups for main pulmonary artery noise (no-shield: 34±9.8, shield: 36.3±7.2, P =0.56), SNR (no-shield: 11.2±3.7, shield: 10.8±2.6, P =0.74) or contrast-to-noise ratio (no-shield: 10.0±3.3, shield: 9.3±2.4, P =0.6). Median subjective image quality scores were comparable (no-shield: 4.0, interquartile range: 3.5 to 4.4, shield: 4.3, interquartile range: 4.0 to 4.5).

CONCLUSION

Combining low-dose CTPA with breast shields confers additional breast-dose savings without impacting image quality and yields breast doses approaching those of low-dose scintigraphy, suggesting breast shields play a role in protocol optimization for select groups.

Gonad contact shielding in digital radiography: A questionnaire survey

PURPOSE

The use of gonad contact shielding (GCS) in radiology departments has varied across countries, possibly because, until recently, there was no agreed consensus with mixed evidence supporting its use. This study aims to explore radiographers' use and opinion on GCS in digital radiography (DR) and to evaluate whether radiographers' use of GCS is associated with their gender, highest educational qualification, and/or years of experience.

METHOD

An online survey was sent via email to potential participants through the Society of Medical Radiographers Malta (SRM) as well as social media posts on local radiography pages. Descriptive and inferential statistics were used to analyse the collected data.

RESULTS

Almost half of the registered radiographers working in radiology departments in Malta (n = 101/203) completed the survey (49.7 % response rate). 61.4 % of participating radiographers indicated they 'often' use GCS in some patients, with 56.4 % stating they perceive GCS as an effective tool to protect the gonads from radiation exposure in DR. Equally, 56.4 % claimed that GCS use is guided by local rules and/or departmental protocols. While 58.4 % indicated that patients' gender does not impact their use of GCS, patients' age does influence their use. No statistically significant association was noted between radiographers' likeliness of using GCS and their gender, highest educational qualification, and/or years of experience.

CONCLUSIONS

Some misconceptions and uncertainties among radiographers concerning the benefits and risks of using GCS were noted. Local radiology departments should look into their protocols and assess the need for an update aligned with the latest recommendations.

Perioperative Anesthetic Management of the Pregnant Patient With Congenital Heart Disease Undergoing Cardiac Intervention: A Systematic Review

Maternal congenital heart disease is increasingly prevalent, and has been associated with a significantly increased risk of maternal, obstetric, and neonatal complications. For patients with CHD who require cardiac interventions during pregnancy, there is little evidence-based guidance with regard to optimal perioperative management. The periprocedural management of pregnant patients with congenital heart disease requires extensive planning and a multidisciplinary teams-based approach. Anesthesia providers must not only be facile in the management of adult congenital heart disease, but cognizant of the normal, but significant, physiologic changes of pregnancy.

A Study of Radiation Protection Standards Compliance in Hospital Radiographic Departments in Iran

Background

The X-ray is a critical diagnostic and therapeutic tool with harmful effects. The International Commission on Radiological Protection (ICRP) has some recommendations regarding applying radiation protection principles.

Objective

This study aimed to determine the standards of the typical radiation protection in radiographic departments of hospitals in Iran.

Material and Methods

In this cross-sectional descriptive study, the usual radiation protection standards in places, such as the physical environment of the control and waiting rooms, radiographic devices, the physical space of the darkroom, and shielding facilities, were investigated using a checklist in Iran. A total of 84 hospitals in 51 cities throughout Iran were randomly selected, and the checklists were distributed to the radiation protection officers. In hospitals with multiple radiography rooms, the radiation protection officers were asked to complete the checklist about the room with the highest workload as a baseline to evaluate their facilities. Finally, the authors reviewed all checklists.

Results

In radiology departments in control and waiting rooms, the mean of radiation protection was 71.9%. Pregnancy and radiation warning signs and labels were present in 96.1% of the parameters, while gonad shielding protocols were not presented.

Conclusion

The principles of observed radiation protection were unsatisfactory, and it is recommended that surveillance be conducted at frequent intervals.

Jordanian women’s (studying or working in medical fields) awareness in terms of the use of dental imaging during pregnancy

Background

The anxiety among pregnant women about the imaging of teeth during pregnancy may have an adverse effect on the oral health of both the mother and the fetus too. This research study was conducted to evaluate women’s knowledge of the utilization of dental imaging during pregnancy.

Methods

In this research, structured questionnaires were distributed electronically through social media. The questionnaires contained questions focused on the women’s (studying or working in medical fields) awareness regarding the ionizing radiation protection that takes place during dental imaging, the safest period for dental imaging, the sort of radiographs that can be required, and the chance of radiation-induced malignant tumor and malformation of the fetal as a result of dental imaging.

Results

Overall, 984 participants completed questionnaires that were analyzed after being received. Most of the participants (n = 637; 64.7%) were < 30 years of age. The greater number of the participants (66.8%) had fair knowledge of dental imaging. 25.4% mentioned that pregnant women are able to do dental imaging during the first trimester. And approximately half of the participants thought that cone-beam computed tomography and panoramic images must not be carried out during pregnancy. Moreover, nearly the same percentage of them also believed that the risk of inborn malformation is high due to dental imaging.

Conclusions

The results refer to a low awareness among people who have medical knowledge regarding dental radiograph protection during pregnancy. This needs to be paid attention to among students, graduates, and workers in medical fields by focusing on the courses and lectures related to dental imaging protection during pregnancy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02459-w.

Paediatric gonad shielding in pelvic radiography: A systematic review and meta-analysis

INTRODUCTION

The British Institute of Radiology (BIR) and American Association of Physicists in Medicine (AAPM) have recommended that gonad shielding is no longer used during pelvic X-ray examinations. The BIR guidance states that shielding may still be considered for use on males, but should not be used on females. This paper aimed to evaluate if this decision was supported by evidence from practice, by comparing the accuracy of gonad shield placement in paediatric males and females.

METHODS

A systematic review of databases including EMBASE, MEDLINE and PubMed was performed in February 2021. Studies were considered eligible if they provided data on the use of gonad shielding during pelvic X-ray examinations on male and female patients under the age of 18. Nine studies met the inclusion criteria and data extraction was performed. Quality appraisal was undertaken, and a meta-analysis of shielding accuracy was performed on seven studies.

RESULTS

The results from the meta-analysis (2187 total radiographs) demonstrated that female patients were significantly more likely (OR 1.38, 95% CI 0.88-1.87) than males to have gonad shields placed inaccurately (p value < 0.001).

CONCLUSION

Gonad shield placement on paediatric female patients is significantly less accurate than on males, and so the results support the AAPM and BIR guidance to stop the practice for females. Shield application may also be frequently inaccurate for males, but the review does not provide clear evidence for or against continuing the practice for males.

IMPLICATIONS FOR PRACTICE

Discontinuing the use of gonad shields in paediatric pelvic radiography on female patients is supported. Any continued use on male patients, or for reasons such as psychological reassurance, should be subject to enhanced training and audit to ensure benefits outweigh any risks.

THE EFFECT OF OUT-OF-PLANE PATIENT SHIELDING ON CT RADIATION EXPOSURE AND TUBE CURRENT MODULATIONS: A PHANTOM STUDY ACROSS THREE VENDORS

The aim of this study was to evaluate how out-of-plane patient shielding affects radiation exposure parameters and tube current modulation on different vendors' computed tomography (CT) scanners. Helical CT scans were performed using two homogenous phantoms to mimic patient attenuation. Four CT scanners from three vendors were investigated by varying the distance of the patient shield from the border of the imaging volume. Scans were performed with a shield placed before and after the localizer. Changes in volume computed tomography dose index (CTDIvol), dose-length product (DLP) and tube current-time products were studied. Out-of-field lead shield increased the CTDIvol and DLP values for each scanner at least for one scan setting when the shield was present in the localizer. The most notable changes were recorded with >1.3 pitch values when the shield was closest to the scanned volume (2.5 cm), and the scan direction was towards the shield. The usage of patient shields in the localizer CT scans can disturb TCM even when placed 7.5 cm away from the edge of the scan.

Comparison of scattered entrance skin dose burden in MSCT, CBCT, and X-ray for suspected scaphoid injury: Regional dose measurements in a phantom model

INTRODUCTION

Scaphoid radiography has poor sensitivity for acute fracture detection and often requires repeat delayed imaging. Although magnetic resonance (MR) imaging is considered the gold standard, computed tomography (CT) is often used as an alternative due to ease of access. Cone-Beam CT (CBCT) offers equivalent diagnostic efficacy to Multi Slice CT (MSCT) at reduced dose. We aimed to establish the difference in scattered dose between modalities for scaphoid imaging.

METHODS

Anatomical regional entrance surface dose measurements were taken at 3 regions on an anthropomorphic torso phantom positioned as a patient to a wrist phantom undergoing scaphoid imaging for three modalities (CBCT, MSCT, four-view projection radiography). Exposure factors were based on audit of clinical exposures. Each dose measurement was repeated three times per anatomical region, modality, exposure setting and projection.

RESULTS

Under unpaired T-test CBCT gave significantly lower mean dose at the neck (1.64 vs 18 mGy), chest (2.78 vs 8.01) and abdomen (1.288 vs 2.93) than MSCT (p < .0001). However CBCT had significantly higher mean dose than four-view radiography at the neck, chest and abdomen (0.031, 0.035, and 0.021 mGy) (p < .0001).

CONCLUSION

CBCT of the wrist carries a significantly higher scattered radiation dose to the neck, chest and abdomen than four view scaphoid radiography, but significantly lower scattered dose than MSCT of the wrist of equivalent diagnostic value.

IMPLICATIONS FOR PRACTICE

The use of CBCT for scaphoid injury carries significantly lower scattered dose to radio-sensitive structures investigated here than equivalent MSCT, and may be of greater use as an early cross-sectional investigation for suspected scaphoid fracture.

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.

European consensus on patient contact shielding

Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control systems have reduced doses and improved image consistency. These changes and a greater understanding of both the benefits and the risks from the use of shielding have led to a review of shielding use in radiology. A number of professional bodies have already issued guidance in this regard. This paper represents the current consensus view of the main bodies involved in radiation safety and imaging in Europe: European Federation of Organisations for Medical Physics, European Federation of Radiographer Societies, European Society of Radiology, European Society of Paediatric Radiology, EuroSafe Imaging, European Radiation Dosimetry Group (EURADOS), and European Academy of DentoMaxilloFacial Radiology (EADMFR). It is based on the expert recommendations of the Gonad and Patient Shielding (GAPS) Group formed with the purpose of developing consensus in this area. The recommendations are intended to be clear and easy to use. They are intended as guidance, and they are developed using a multidisciplinary team approach. It is recognised that regulations, custom and practice vary widely on the use of patient shielding in Europe and it is hoped that these recommendations will inform a change management program that will benefit patients and staff.

European consensus on patient contact shielding

Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control (AEC) systems have reduced doses and improved image consistency. These changes and a greater understanding of both the benefits and the risks from the use of shielding have led to a review of shielding use in radiology. A number of professional bodies have already issued guidance in this regard. This paper represents the current consensus view of the main bodies involved in radiation safety and imaging in Europe: European Federation of Organisations for Medical Physics, European Federation of Radiographer Societies, European Society of Radiology, European Society of Paediatric Radiology, EuroSafe Imaging, European Radiation Dosimetry Group (EURADOS), and European Academy of DentoMaxilloFacial Radiology (EADMFR). It is based on the expert recommendations of the Gonad and Patient Shielding (GAPS) Group formed with the purpose of developing consensus in this area. The recommendations are intended to be clear and easy to use. They are intended as guidance, and they are developed using a multidisciplinary team approach. It is recognised that regulations, custom and practice vary widely on the use of patient shielding in Europe and it is hoped that these recommendations will inform a change management program that will benefit patients and staff.

European consensus on patient contact shielding

Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control (AEC) systems have reduced doses and improved image consistency. These changes and a greater understanding of both the benefits and the risks from the use of shielding have led to a review of shielding use in radiology. A number of professional bodies have already issued guidance in this regard. This paper represents the current consensus view of the main bodies involved in radiation safety and imaging in Europe: European Federation of Organisations for Medical Physics, European Federation of Radiographer Societies, European Society of Radiology, European Society of Paediatric Radiology, EuroSafe Imaging, European Radiation Dosimetry Group (EURADOS), and European Academy of DentoMaxilloFacial Radiology (EADMFR). It is based on the expert recommendations of the Gonad and Patient Shielding (GAPS) Group formed with the purpose of developing consensus in this area. The recommendations are intended to be clear and easy to use. They are intended as guidance, and they are developed using a multidisciplinary team approach. It is recognised that regulations, custom and practice vary widely on the use of patient shielding in Europe and it is hoped that these recommendations will inform a change management program that will benefit patients and staff.

Impact of Eye and Breast Shielding on Organ Doses During Cervical Spine Radiography: Design and Validation of MIRD Computational Phantom

Purpose: The study aimed to design and validate computational phantoms (MIRD) using the MCNPX code to assess the impact of shielding on organ doses. Method: To validate the optimized phantom, the obtained results were compared with experimental results. The validation of the optimized MIRD phantom was provided by using the results of a previous anthropomorphic phantom study. MIRD phantom was designed by considering the parameters used in the anthropomorphic phantom study. A test simulation was performed to compare the dose reduction percentages (%) between the experimental anthropomorphic phantom study and the MCNPX-MIRD phantom. The simulation was performed twice, with and without shielding materials, using the same number and locations of the detector. Results: The absorbed dose amounts were directly extracted from the required organ and tissue cell parts of output files. Dose reduction percentages between the simulation with shielding and simulation without shielding were compared. The highest dose reduction was noted in the thymus (95%) and breasts (88%). The obtained dose reduction percentages between the anthropomorphic phantom study and the MCNPX-MIRD phantom were highly consistent and correlated values with experimental anthropomorphic data. Both methods showed Relative Difference (%) ranges between 0.88 and 2.22. Moreover, the MCNPX-MIRD optimized phantom provides detailed dose analysis for target and non-target organs and can be used to assess the efficiency of shielding in radiological examination. Conclusion: Shielding breasts and eyes during cervical radiography reduced the radiation dose to many organs. The decision to not shield patients should be based on research evidence as this approach does not apply to all cases.

Using patient shielding - What is the risk?

The practice of placing radiation protective shielding on patients ('in contact') in order to reduce the dose to certain radiosensitive organs for diagnostic X-ray examination, has been employed for decades. However, there has been a growing body of evidence that this practice is often ineffective or even counterproductive and the use of such shielding can also overemphasise the hazards of ionising radiation in the public mind. This has led to a growing disparity in the application of patient contact shielding and culminated in several professional bodies issuing guidance and statements to provide a consistent approach to patient contact shielding. This, in turn, has led to a healthy discussion and re-evaluation of when and why patient contact shielding should be used, where the main issue centres around the criteria used to arrive at the recommendations. The decision process involves considering, among others, the reported effectiveness of the shielding and a subjective assessment of the subsequent risks from their use. In order to improve the transparency of these recommendations, it is therefore suggested that a threshold for dose and/or risk should be clearly stated, below which no protection is required. A suggested starting point for defining this threshold is discussed. This would enhance uniformity of application and provide clarity for staff, patients and the public. It would also ensure that any future research in this area could be easily incorporated into the general guidance.

Women's awareness regarding the use of dental imaging during pregnancy

Background

There is often anxiety among pregnant women about dental imaging during pregnancy. This may hinder some women from seeking dental treatment during pregnancy and consequently, may negatively affect the oral health of the mother and fetus. This study was conducted to assess women’s awareness regarding the use of dental imaging during pregnancy.

Methods

In this cross-sectional study, the electronic distribution of structured questionnaires was done via social media. The self-administered questionnaires contained questions related to women’s knowledge regarding the radiation protection measures during dental imaging, the safest period for dental imaging, the type of radiographs that can be acquired during pregnancy, and the possibility of radiation-induced malignancy and fetal malformation as a result of dental imaging.

Results

In total, 410 completed questionnaires were received and analyzed. More than half of the participants were 30–49 years of age. The majority of the participants (91%) demonstrated poor knowledge concerning dental imaging. Only 4% reported that pregnant women can have dental imaging during any trimester. The majority believed that panoramic images and cone-beam computed tomography should not be acquired during pregnancy. The majority also believed there is a high risk of congenital malformation due to dental imaging and were unsure about the oncogenic risks.

Conclusions

Our study suggests that there is insufficient knowledge about dental imaging safety during pregnancy. This misconception may have a direct impact on the attitude toward seeking dental care. Therefore, community awareness initiatives aimed at informing our society about radiation exposure, safety, and required protection measures are critical.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01726-6.

Dental cone beam CT: An updated review

Cone beam computed tomography (CBCT) is a diverse 3D x-ray imaging technique that has gained significant popularity in dental radiology in the last two decades. CBCT overcomes the limitations of traditional two-dimensional dental imaging and enables accurate depiction of multiplanar details of maxillofacial bony structures and surrounding soft tissues. In this review article, we provide an updated status on dental CBCT imaging and summarise the technical features of currently used CBCT scanner models, extending to recent developments in scanner technology, clinical aspects, and regulatory perspectives on dose optimisation, dosimetry, and diagnostic reference levels. We also consider the outlook of potential techniques along with issues that should be resolved in providing clinically more effective CBCT examinations that are optimised for the benefit of the patient.

APQS consensus regarding patient shielding during routine radiographic imaging

Shielding, particularly of the gonads, has been a routine part of diagnostic radiographic imaging for many years. However, recent thinking suggests that such shielding may offer little benefit, and in some cases may actually cause harm, e.g. by obscuring anatomy or paradoxically increasing patient radiation dose secondary to the need for repeat imaging. This thinking has led many institutions in the West to abandon routine shielding. However, in Asia, shielding is still commonplace. It was felt that the Asia-Pacific Forum on Quality and Safety in Medical Imaging (APQS) was an ideal place to discuss the merits of shielding and deliver a pan-Asian consensus. The APQS is an annual meeting that convenes radiation safety and imaging quality experts from all of the major Asian regions. During the 2020 APQS meeting, radiation safety experts from each region discussed their opinions of shielding during a dedicated session. These experts' views were mostly in line with the views of Western radiologists. However, important country specific and cultural factors were noted by each of the experts. A pan-Asian consensus was issued by the forum. It is hoped that this consensus will guide the development of future shielding policies throughout Asia.

Neurocritical Care of the Pregnant Patient

Purpose of review

To summarize recent changes in management and emerging therapies for pregnant neurocritical care patients.

Recent findings

Diagnostic and treatment options for managing neurologic emergencies in pregnant patients have expanded with both greater understanding of the effects of imaging modalities and medications on pregnancy and application of standard treatments for non-pregnant patients to pregnant populations. Specifically, this includes cerebrovascular diseases (pregnancy-associated ischemic stroke, pregnancy-associated intracerebral hemorrhage, cerebral venous sinus thrombosis), post-maternal cardiac arrest care, seizures and status epilepticus, myasthenia gravis, and fetal somatic support in maternal death by neurologic criteria.

Summary

With the exception of direct abdominal computed tomography (CT), most imaging studies are reasonably safe in pregnancy. When emergent imaging is needed to prevent maternal morbidity or mortality, any CT sequence with or without contrast is appropriate to pursue. Though new safety data on antiplatelets, antihypertensives, thrombolytics, and antiepileptic drugs have increased options for disease management in pregnancy, unfractionated and low-molecular weight heparin remain the safest options for anticoagulation. Early studies on hypothermia, ketamine, and immunomodulating therapies in pregnancy are promising. In myasthenia gravis, new data on adjunct devices may allow more patients to undergo safe vaginal delivery, avoiding cesarean section and the associated risk of crisis. When difficult decisions regarding preterm delivery arise, recent outcome studies can help inform discussion. Lastly, when the feared complication of maternal death by neurologic criteria occurs, fetal somatic support may help to save at least one life.

Use of out-of-field contact shielding on patients in medical imaging: A review of current guidelines, recommendations and legislative documents

The use of patient contact-shielding has become a topic of intensive scientific debate. While it has been common practice during the last decades, some studies have questioned the efficiency of using such shielding while others have highlighted the inconsistencies in its application. The objective of this work is to review current recommendations and legislative documents on the use of out-of-field shielding in X-ray imaging, including those from national authorities and from international and national organisations and professional bodies. The review, performed within the framework of the activities of EURADOS Working Group 12, covers available recommendations on use of contact shielding in adult, pregnant and paediatric patients in general radiography, fluoroscopy, computed tomography, mammography and dental radiology. It includes a comprehensive search of 83 documents from 32 countries and 6 international organisations over the last 39 years. In general, using shielding is recommended only under two conditions: if it does not compromise the diagnostic task and the performance of the procedure and/or if it reassures the patient and comforters that they are appropriately protected against potentially harmful effects of radiation. There are very few specific regulatory requirements to use shielding in a particular imaging modality, although they may consider use of shielding either as part of good radiological practice or as requirements for availability of protective or ancillary tools, without further specification of their use. There is a wide variety of positions among documents that recommend out-of-field shielding, those that do not recommend it and those that are not specific. Therefore, evidence-based consensus is still needed to ensure best and consistent practice.

Radiation use in diagnostic imaging in children: approaching the value of the pediatric radiology community

Medical imaging is foundational in the care of children, and much of the medical imaging province depends on ionizing radiation: radiography, fluoroscopy, CT and nuclear imaging. Many considerations for this imaging in children are distinct in the domains of appropriate radiation use, other factors that determine examination quality, the opportunities to engage and educate through networking, and the translation of research efforts. Given these needs, it is worth approaching the contributions and their impact by the pediatric radiology community, especially to the enhancement of this value in the care of children.

Canadian Society of Thoracic Radiology/Canadian Association of Radiologists Best Practice Guidance for Investigation of Acute Pulmonary Embolism, Part 1: Acquisition and Safety Considerations

Acute pulmonary embolism (APE) is a well-recognized cause of circulatory system compromise and even demise which can frequently present a diagnostic challenge for the physician. The diagnostic challenge is primarily due to the frequency of indeterminate presentations as well as several other conditions which can have a similar clinical presentation. This often obliges the physician to establish a firm diagnosis due to the potentially serious outcomes related to this disease. Computed tomography pulmonary angiography (CTPA) has increasingly cemented its role as the primary investigation tool in this clinical context and is widely accepted as the standard of care due to several desired attributes which include great accuracy, accessibility, rapid turn-around time and the ability to suggest an alternate diagnosis when APE is not the culprit. In Part 1 of this guidance document, a series of up-to-date recommendations are provided to the reader pertaining to CTPA protocol optimization (including scan range, radiation and intravenous contrast dose), safety measures including the departure from breast and gonadal shielding, population-specific scenarios (pregnancy and early post-partum) and consideration of alternate diagnostic techniques when clinically deemed appropriate.

A retrospective audit of cumulative ionising radiation levels in hospitalised pregnant patients

BACKGROUND

Among hospitalised patients, diagnostic radiation is possibly used least on pregnant patients due to the fear of ionising radiation on the fetus; however, what levels are currently being prescribed?

AIMS

To assess the cumulative levels of ionising radiation received by pregnant patients during a single admission to a tertiary hospital.

MATERIALS AND METHODS

A retrospective audit of pregnant patients admitted to Flinders Medical Centre, South Australia, Australia, between 2013 and 2017 inclusive was performed. All procedures utilising ionising radiation were collected including conventional radiology, computed tomography, fluoroscopy and nuclear medicine. Individual and cumulative effective doses for mother and fetus were calculated using patient dose reports and published conversion factors.

RESULTS

From 547 patients, the median cumulative effective dose was 0.02 mSv and only five patients received more than 10 mSv, with 19.07 mSv the highest dose received. The median fetal cumulative effective dose was 0.01 mSv but only three fetuses received more than 10 mSv, likely due to fetal exclusion in some procedural fields of view. Stays longer than ten days were associated with significantly higher cumulative effective dose, as did those with maternal cardiovascular related admission, for both maternal and fetal exposures.

CONCLUSION

These results suggest that pregnant patients are exposed to low doses of ionising radiation, in both individual procedures and cumulative doses. The detrimental risks associated with these levels of ionising radiation are not overt and so clinicians should question which risk is higher, the ionising radiation from the radiological procedures received or the lack of diagnostic information if avoided?

Imaging modalities in pregnant cancer patients

Cancer during pregnancy is increasingly diagnosed due to the trend of delaying pregnancy to a later age and probably also because of increased use of non-invasive prenatal testing for fetal aneuploidy screening with incidental finding of maternal cancer. Pregnant women pose higher challenges in imaging, diagnosis, and staging of cancer. Physiological tissue changes related to pregnancy makes image interpretation more difficult. Moreover, uncertainty about the safety of imaging modalities, fear of (unnecessary) fetal radiation, and lack of standardized imaging protocols may result in underutilization of the necessary imaging tests resulting in suboptimal staging. Due to the absence of radiation exposure, ultrasound and MRI are obvious first-line imaging modalities for detailed locoregional disease assessment. MRI has the added advantage of a more reproducible comprehensive organ or body region assessment, the ability of distant staging through whole-body evaluation, and the combination of anatomical and functional information by diffusion-weighted imaging which obviates the need for a gadolinium-based contrast-agent. Imaging modalities with inherent radiation exposure such as CT and nuclear imaging should only be performed when the maternal benefit outweighs fetal risk. The cumulative radiation exposure should not exceed the fetal radiation threshold of 100 mGy. Imaging should only be performed when necessary for diagnosis and likely to guide or change management. Radiologists play an important role in the multidisciplinary team in order to select the most optimal imaging strategies that balance maternal benefit with fetal risk and that are most likely to guide treatment decisions. Our aim is to provide an overview of possibilities and concerns in current clinical applications and developments in the imaging of patients with cancer during pregnancy.

Perceptions of radiographers regarding establishing a self-regulatory body for radiation safety in Eswatini

INTRODUCTION

Eswatini remains one of the countries in Southern Africa without a regulating authority for radiation safety in the radiography departments. Quality control (QC) tests and radiation protection practices are unmonitored. This study sought to explore radiographers' perceptions regarding establishing a self-regulatory body that will formulate, implement and monitor compliance of standardised guidelines for radiation safety.

METHODS

A qualitative, exploratory and descriptive research approach was undertaken. Radiographers currently registered and practicing in Eswatini were purposively selected and invited to participate. Data was collected using semi-structured interviews. Audiotapes and field notes were used. Audio taped interviews were transcribed verbatim and then analyzed using qualitative content analysis.

RESULTS

Six themes emerged from the analysis of data, namely; a) awareness of the need for QC tests, b) radiation protection and safety in the radiography departments, c) radiographers' responsibility towards radiation protection, d) education and training in radiation safety for radiographers and other stakeholders, e) support from governmental and management structures and f) the need for the self-regulatory body in the radiography departments.

CONCLUSION

The study demonstrated that there is awareness among radiographers in Eswatini that radiation safety practices are necessary in the radiography departments. Continuous education and training were deemed as imperative to improve radiation safety in the radiography departments. There is also support for the idea of establishing the self-regulatory body.

IMPLICATIONS FOR PRACTICE

The need for monitoring structures in order to ensure radiation safety in the radiography departments is highlighted in this study. Government officials and hospital management are crucial in ensuring radiation safety in radiography departments.

THE EFFICACY OF RADPAD AS A RADIATION PROTECTION TOOL IN CT FLUOROSCOPY GUIDED LUNG BIOPSIES

Computed tomography fluoroscopy is now the preferred technique for percutaneous lung biopsies. However, concern regarding operator and patient radiation dose remains, which warrants further exploration into dose optimisation tools. This phantom-study aims to assess the dose reduction capabilities of RADPAD, a single-use patient drape designed to decrease staff exposure to scattered radiation. Dosemeters at the waist and eye levels were used to determine the whole-body and lens exposure during simulated lung biopsy procedures while using RADPAD and other combinations of personal protective equipment. RADPAD resulted in a 36% and 38% dose reduction for whole-body and eye exposure, respectively. However, when used in combination with radioprotective eyewear and aprons, RADPAD did not reduce the radiation dose further. Consequently, the use of standard personal protective equipment is a more cost-effective option for staff dose reduction. RADPAD is useful in the reduction of radiation dose to unprotected regions.