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.