Gonad shielding in paediatric pelvic radiography: Effectiveness and practice Thomas Warlow a , Peter Walker-Birch b , Philip Cosson b, * a Radiology Department, King’s Mill Hospital, Mansfield Road, Sutton in Ashfield, Nottinghamshire NG17 4JL, UK b Medical Imaging, Teesside University, Middlesbrough TS1 3BA, UK article info Article history: Received 30 September 2013 Received in revised form 6 January 2014 Accepted 16 January 2014 Available online xxx Keywords: Pelvis Ovary Gonads Protective devices Radiation protection Radiography abstract The use of Gonad Shields (GS) has been advocated during pelvic radiography since the 1950’s, particu- larly in children where the risks from radiation are higher. Previous literature reports that GS are often omitted and rarely used correctly. Objectives: Presentation of findings concerning use of GS in the context of previous data in the literature, and recommend any appropriate actions. Method: A retrospective analysis of images from an existing DICOM Digital Teaching Library (DTL) was conducted. Images of the pelvis from paediatric patients were reviewed and scored on whether a GS was present and (if present) whether the shield was considered to adequately protect the gonads. Results: 130 images were reviewed. 70 male and 60 female. The gonads were deemed to be protected by a shield in 22 images (17%), inadequately protected when a shield was used in 44 images (34%) with the remaining 64 images (49%) having no shield at all. A lack of adequate protection for the gonads was found, with females more likely to be inadequately protected than males (c 2 ¼ 19.009, df ¼ 1, p < 0.001). These findings become more clinically significant when reports of ovaries lying outside of the pelvic basin (in paediatric patients) are considered. Conclusions: The current practice of gonad shielding is neither effective nor beneficial for female pae- diatric patients, incorrect shield placement can often require repeat exposures. This finding is commensurate with previous literature. Therefore, gonad shielding is no longer an appropriate opti- mization tool for female paediatric patients during conventional radiography of the pelvis, and should be abandoned. Ó 2014 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. Introduction Projection Radiography of the pelvis is a currently indicated investigation in assessing hip pathologies in paediatrics. 1,2 The treatment of childhood diseases such as developmental hip dysplasia, slipped upper femoral epiphysis (SUFE) and Perthes’ disease can often require long term investigation and numerous radiographs. The European Directive on health protection identifies children as a special practice that merit particular attention from the radi- ation protection point of view. 3 Radiation induced cancer risks to children are higher than the average for the whole population, the risk for children aged 0e9 is twice that compared with an adult in their thirties. 4 Radiation protection during radiography of the pelvis has always been portrayed as challenging due to the location of reproductive organs (the gonads). Irradiating the germ cells within the gonads is reported to cause genetic mutation which has the potential to develop into hereditary disease passed down and expressed in future generations, making the risks during pelvic radiography therefore two-fold, with the potential for both somatic and genetic mutations. 5,6,2 The International Commission on Radiological Protection (ICRP) has traditionally seen the gonads as a radiosensitive organ with the highest tissue weighting factor of any organ. 7 However, this was recently revised down from a tissue weighting factor of 0.2 to 0.08 8 (below that given to Bone-marrow, Colon, Lung, Stomach, and Breast; all of which have a tissue weighting of 0.12). This revision was based largely on the lack of direct evidence supporting the link between gonad irradiation and heritable disease in future * Corresponding author. Tel.: þ44 01642 384175. E-mail addresses: Thomas.Warlow@SFH-TR.NHS.UK (T. Warlow), P.Walker- Birch@tees.ac.uk (P. Walker-Birch), p.cosson@tees.ac.uk, philip.cosson@ shaderware.com (P. Cosson). Contents lists available at ScienceDirect Radiography journal homepage: www.elsevier.com/locate/radi 1078-8174/$ e see front matter Ó 2014 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.radi.2014.01.002 Radiography xxx (2014) 1e5 Please cite this article in press as: Warlow T, et al., Gonad shielding in paediatric pelvic radiography: Effectiveness and practice, Radiography (2014), http://dx.doi.org/10.1016/j.radi.2014.01.002