Exploring Past to Present Shielding Guidelines

Purpose: To explore the data and supporting evidence for the 2019 statement by the American Association of Physicists in Medicine (AAPM) that recommends limits to the routine use of fetal and gonadal shielding in medical imaging.

Methods: Three researchers searched 5 online databases, selecting articles from scholarly journals and radiology trade publications. Search results were filtered to include literature published from January 1, 2016, to August 9, 2022, to ensure relevance and provide historical background for the 2019 AAPM statement.

Results: The use of patient shielding during medical imaging did not reduce dose, and in certain instances, increased dose received by patients during computed tomography, fluoroscopy, or dental imaging. The use of shielding interfered with technology designed to reduce patient dose, including automatic exposure control and dose modulation. Research showed that errors in shield placement were common and that shields can act as sources of infection or carriers of harmful lead dust.

Discussion: In each article reviewed, a compelling case was made for discontinuing routine patient shielding during radiographic procedures. Serious opposition to the discontinuation of the shielding practice was not found. Opportunities exist for further study into technologists' and the public's understanding of the effects of radiation and technologists' compliance with new shielding policies.

Conclusion: The challenges with properly using shielding, paired with recent technological advancements and a new understanding of radiation protection, have negated the need for contact shielding. This legacy practice can be discontinued in clinical settings, and educational materials for technologists and students should be updated to reflect these changes.