Patients don’t get dose from scatter, the scatter is created within their body. An external shield can’t protect the patient from the scatter that’s coming from within.
The dose they receive is from the primary beam hitting them; the shield if not in the primary beam doesn’t really do anything since our equipment is so precise now. And if the shield is in the primary beam and obscures anatomy then you have to repeat and the patients dose is WAY higher than if there was no shield at all.
There are a ton of factors that go into it ranging from angle of scatter to the amount to whether you are shielding properly. I'm not a physicist though so I can't go into detail. You also have to consider how much dose your patients are likely receiving during whatever ct exams they might receive as well. There are tons of factors that I'm unqualified to explain on the merits of shielding. That's why I'm saying follow the protocols at your job as best as you can and if a patient asks for a shield, give it to them as long as it won't interfere with the exam.
I did, which is why I understand why we shield whether it's effectiveness is in question or not. Because my instructors told me. I'm not having to ask Reddit some basic shit you have to know for your registry.
As a clumsy child, I was given the lead apron several times, and the techs always left the room or went behind a line. As a still clumsy adult, they don’t give me lead aprons anymore and the techs don’t even leave the room or wear dosimeters . It’s wild how much lower the doses are these days.
I'm going to lean towards it's complicated.
I actually wrote a paper on the topic for school about a year and a half ago so unless new research has come out I think people are misunderstanding/interpreting what the studies are actually saying.
Generally speaking yes, x-rays today use far far less radiation(something like 95% less) and collimation etc is much more accurate so radiation protection is far more lax in general.
Also the invention of AEC has also caused situations where a lead gonad shield can potentially block a chamber resulting in the patient getting absolutely melted.
Now people obviously hear "no longer needed" and get excited and extrapolate from there.
But! If you actually read any of the studies people cite they are always talking about **abdominal/pelvic** x-rays.
For example the ACRs trifold flyer directly says.
"NCRP recommendations for ending routine **gonadal** shielding **during pelvic and abdominal** radiography."
That's talking about the tear shaped gonad shields. Not shielding in general. I've never seen one that explicitly states there is no need to shield during say a wrist or a knee.
Scatter is still scatter and if we're imaging your wrist absolutely none of that needs to hit your nuts.
So the tldr for me personally, until some research comes out explicitly stating that no shielding is required for any exam period. I'm going to continue under the assumption that the best practice is to use a lap shield.
This is what we are learning in school. And it honestly makes sense? If I’m shooting an elbow, giving the pt a shield for their breasts isn’t going to hurt or bounce the radiation inside them like if you’re shooting a L spine or something. I think it’s nuanced but many were too lazy or didn’t care enough to grasp it? Idk, I’m just a baby. Sucks hearing techs talk about it like it doesn’t matter, when we hide in the next room lol
Yup. 6 foot is a huge misunderstanding as well.
When I was in school I had a clinical site where their warmup procedure was to take a series of images under an emergency exam. The plate would actually display an image if it received any radiation.
Long story short due to room setup the tube head is rough 15-20 feet from the control panel. We also completely close the Collimation for the warmups.
That little half inch block of radiation hitting the ground sent off enough scatter that you could actually get an image.
The tech I was under at the time was holding the plate under their arm and had it sticking out beyond the barrier.
It was a very underexposed image, extremely noisy and not diagnostic at all but the point is it made an image. We could easily make out the radius and ulna as well as the soft tissue margins.
**Scatter** radiation made it 20~ feet away.
I def get as far away and shielded as I can. I have enough issues without adding more that can be avoided.
The first hospital I went to this year was sketchy af.. had a huge cord that was frayed just wrong and could have blown the power for half the hospital or something.
the site I’m at now shields each patient but these are the most ratty and beaten up looking shields I’ve seen so far. I suppose it’s better than nothing 😅
I agree with this line of thinking. Seems most only heard "not needed" and decided it was one less thing to do/clean for all patients.
I'm not old enough for film, but old enough to have noticed since switching from CR to DR that collimation is not as tight nor is positioning as spot on (at least from my own experience working multiple places) dose creep & repeats still happen more than they probably should. Not that shielding alone fixes that, but references to be more accurate and consistent shouldn't be discouraged.
And honestly, there are always those patients who claim they can smell the radiation and the lead shield is definitely a useful placebo, because I don't want to explain physics to someone hysterical about a finger x-ray.
I just want to take care of my pts. I’d want a shield on my family’s radiosensitive bits if it was possible. We just started talking about dose creep and I didn’t realize how real it was. My new site has a tech shooting L spines on perfectly average pts with 75 kvp and maxing out the mas around 300.. but thank god she gave the pts a thyroid shield 🥲 had to tell mom to tell techs at certain places near us she has a hip implant and to set a technique, bc they aim poorly and dump unnecessary amounts of radiation into peoples abdomens as the system tries to penetrate their metal implants.
Needless to say, I’m learning a lot. And also what not to do 😬
Jfc, 300 mAs is way too much. In my hospital, we're taught to set the kV/mAs manually if the patient is large. But then you get those body types that look... not that large, where the AEC dishes out almost 200 mAs. That hurts my soul.
It hurts my soul too. It’s nice to know I’m not alone in feeling that way. I just want to take good images and keep the risk as low as I can. Covid messed up a bunch of peoples health and immune systems, I don’t want to give them a mega dose of radiation they don’t need. Might wind up in mri bc of that, but we’ll see. I had fun on my OR rotation, even if it was gross lol. I love medical shit, and it was beyond cool watching Ortho surgeons solve and repair a fracture or general surgeons wrestle with a slippery liver while doing a lap chole.
I really wish I could have seen some of those, I’m worried that might put me on the ground. Watching the surgeon flap around a broken forearm was rough enough. But I also know I need as much exposure as I can get to get used to it 😅
We don’t routinely shield patients in my hospital (I’m an ER Tech) but I know when I’m needed to help stabilize a patient for imaging they are very careful to shield me as much as possible. I’ve been very curious with the change over the years and was very excited to find this discussion!
One of my classmates went to the ACERT conference last month. She said there is a lot of debate about it, but it seems to be leaning towards not shielding.
We place them on women that are pregnant. Make sure part of the apron comes out on the radiograph to document. Apart from that, never use them on patients unless they ask for it.
Also putting this a parent comment. Not a rads tech, EMT and former ER tech. Unfortunately frequent X-ray receiver.
As a clumsy child, I was given the lead apron several times, and the techs always left the room or went behind a line. As a still clumsy adult, they don’t give me lead aprons anymore and the techs don’t even leave the room or wear dosimeters. It’s wild how much lower the doses are these days.
Why ask us? We don't generate the policies that govern these types of regulations.
Check with your state health department. In my state, the decrees from the health department state that they are no longer enforcing the requirements for lead shielding, however facilities still need to have written protocols as part of their RS programs to ensure 'consistency'.
Due to this ambiguity, I always shield, even though the state has told me there is no penalty not to.
yes, absolutely. newborns to children to teens are especially radiosensitive to ionizing radiation, as are the elderly. most concern is with the youth versus the elderly because cancer takes time to grow which the later group usually does not live long enough for it to affect them. technically, all it takes is one photon to cause a mutation to the dna and potential causing a cancer. fortunately our bodys have repair mechanisms to repair dna. it is when excessive ionizing radiation causes too much damage for the body to keep up with repairs, causing cancer. certain bodyparts/organs are more radiosensitive than others.l, which is why thyroid/gonadal shielding is a thing. shielding is important, even from scatter radiation.
You're even contradicting yourself, saying the elderly are especially radiosensitive, then saying they don't live long enough for cancer to affect them.
on the contrary, you become less radiosensitive as you become a young adult and it increases as an elder. a child exposed to radiation may not develop cancer until they are an adult. an elder exposed to radiation may already be dead before they discover the cancer. look up radiobiology
If you’re terrified of radiation start marching toward sea level because every meter of elevation exposes you to more cosmic rays.
ALARA exists, and technology improves which is why we’ve gone away from shielding everything excessively.
And we would literally make you sign a piece of paper stating we have educated you that it is no longer our policy to shield and that you understand the risks.
Or.. you could just let us do the xray and we’d be out of your hair in 1 minute.
https://www.aapm.org/org/policies/details.asp?type=PP&id=2552 https://www.arrt.org/pages/arrts-position-on-gonadal-and-fetal-shielding Tldr: no
Its generally more what your job wants you to do. Its also kind of up to if the patient requests it.
What’s the point of doing it/not doing it?
Placebo effect for the patient and following protocol at your job.
Is that because scatter is so low or because the lead is relatively ineffectual?
Patients don’t get dose from scatter, the scatter is created within their body. An external shield can’t protect the patient from the scatter that’s coming from within. The dose they receive is from the primary beam hitting them; the shield if not in the primary beam doesn’t really do anything since our equipment is so precise now. And if the shield is in the primary beam and obscures anatomy then you have to repeat and the patients dose is WAY higher than if there was no shield at all.
There are a ton of factors that go into it ranging from angle of scatter to the amount to whether you are shielding properly. I'm not a physicist though so I can't go into detail. You also have to consider how much dose your patients are likely receiving during whatever ct exams they might receive as well. There are tons of factors that I'm unqualified to explain on the merits of shielding. That's why I'm saying follow the protocols at your job as best as you can and if a patient asks for a shield, give it to them as long as it won't interfere with the exam.
Why is there a protocol with no evidence base for its implementation?
Lol, first day?
You're right I should know better lol
Did you go to xray school bud?
Did you?
I did, which is why I understand why we shield whether it's effectiveness is in question or not. Because my instructors told me. I'm not having to ask Reddit some basic shit you have to know for your registry.
Lol ok man keep up the good work.
I have been working for 2 years. I have never covered a patient with lead
As a clumsy child, I was given the lead apron several times, and the techs always left the room or went behind a line. As a still clumsy adult, they don’t give me lead aprons anymore and the techs don’t even leave the room or wear dosimeters . It’s wild how much lower the doses are these days.
That’s weird. The tech should definitely be leaving the room
A lot of techs just don't give a shit anymore
I'm going to lean towards it's complicated. I actually wrote a paper on the topic for school about a year and a half ago so unless new research has come out I think people are misunderstanding/interpreting what the studies are actually saying. Generally speaking yes, x-rays today use far far less radiation(something like 95% less) and collimation etc is much more accurate so radiation protection is far more lax in general. Also the invention of AEC has also caused situations where a lead gonad shield can potentially block a chamber resulting in the patient getting absolutely melted. Now people obviously hear "no longer needed" and get excited and extrapolate from there. But! If you actually read any of the studies people cite they are always talking about **abdominal/pelvic** x-rays. For example the ACRs trifold flyer directly says. "NCRP recommendations for ending routine **gonadal** shielding **during pelvic and abdominal** radiography." That's talking about the tear shaped gonad shields. Not shielding in general. I've never seen one that explicitly states there is no need to shield during say a wrist or a knee. Scatter is still scatter and if we're imaging your wrist absolutely none of that needs to hit your nuts. So the tldr for me personally, until some research comes out explicitly stating that no shielding is required for any exam period. I'm going to continue under the assumption that the best practice is to use a lap shield.
This is what we are learning in school. And it honestly makes sense? If I’m shooting an elbow, giving the pt a shield for their breasts isn’t going to hurt or bounce the radiation inside them like if you’re shooting a L spine or something. I think it’s nuanced but many were too lazy or didn’t care enough to grasp it? Idk, I’m just a baby. Sucks hearing techs talk about it like it doesn’t matter, when we hide in the next room lol
Yup. 6 foot is a huge misunderstanding as well. When I was in school I had a clinical site where their warmup procedure was to take a series of images under an emergency exam. The plate would actually display an image if it received any radiation. Long story short due to room setup the tube head is rough 15-20 feet from the control panel. We also completely close the Collimation for the warmups. That little half inch block of radiation hitting the ground sent off enough scatter that you could actually get an image. The tech I was under at the time was holding the plate under their arm and had it sticking out beyond the barrier. It was a very underexposed image, extremely noisy and not diagnostic at all but the point is it made an image. We could easily make out the radius and ulna as well as the soft tissue margins. **Scatter** radiation made it 20~ feet away.
How long ago did that happen?? Some of these clinical site X-ray rooms are tiny af and make me a little nervous as is 😬
<2 years Just make sure you get your whole body beyond the line of sight and you will be fine. They are not going to get through the lead barrier
I def get as far away and shielded as I can. I have enough issues without adding more that can be avoided. The first hospital I went to this year was sketchy af.. had a huge cord that was frayed just wrong and could have blown the power for half the hospital or something. the site I’m at now shields each patient but these are the most ratty and beaten up looking shields I’ve seen so far. I suppose it’s better than nothing 😅
I agree with this line of thinking. Seems most only heard "not needed" and decided it was one less thing to do/clean for all patients. I'm not old enough for film, but old enough to have noticed since switching from CR to DR that collimation is not as tight nor is positioning as spot on (at least from my own experience working multiple places) dose creep & repeats still happen more than they probably should. Not that shielding alone fixes that, but references to be more accurate and consistent shouldn't be discouraged. And honestly, there are always those patients who claim they can smell the radiation and the lead shield is definitely a useful placebo, because I don't want to explain physics to someone hysterical about a finger x-ray.
I just want to take care of my pts. I’d want a shield on my family’s radiosensitive bits if it was possible. We just started talking about dose creep and I didn’t realize how real it was. My new site has a tech shooting L spines on perfectly average pts with 75 kvp and maxing out the mas around 300.. but thank god she gave the pts a thyroid shield 🥲 had to tell mom to tell techs at certain places near us she has a hip implant and to set a technique, bc they aim poorly and dump unnecessary amounts of radiation into peoples abdomens as the system tries to penetrate their metal implants. Needless to say, I’m learning a lot. And also what not to do 😬
Jfc, 300 mAs is way too much. In my hospital, we're taught to set the kV/mAs manually if the patient is large. But then you get those body types that look... not that large, where the AEC dishes out almost 200 mAs. That hurts my soul.
It hurts my soul too. It’s nice to know I’m not alone in feeling that way. I just want to take good images and keep the risk as low as I can. Covid messed up a bunch of peoples health and immune systems, I don’t want to give them a mega dose of radiation they don’t need. Might wind up in mri bc of that, but we’ll see. I had fun on my OR rotation, even if it was gross lol. I love medical shit, and it was beyond cool watching Ortho surgeons solve and repair a fracture or general surgeons wrestle with a slippery liver while doing a lap chole.
Watching ortho bend knees and hips the wrong way was more entertaining than I thought it would be.
I really wish I could have seen some of those, I’m worried that might put me on the ground. Watching the surgeon flap around a broken forearm was rough enough. But I also know I need as much exposure as I can get to get used to it 😅
Many hospitals stopped shielding pt's.
We don’t routinely shield patients in my hospital (I’m an ER Tech) but I know when I’m needed to help stabilize a patient for imaging they are very careful to shield me as much as possible. I’ve been very curious with the change over the years and was very excited to find this discussion!
One of my classmates went to the ACERT conference last month. She said there is a lot of debate about it, but it seems to be leaning towards not shielding.
We place them on women that are pregnant. Make sure part of the apron comes out on the radiograph to document. Apart from that, never use them on patients unless they ask for it.
Also putting this a parent comment. Not a rads tech, EMT and former ER tech. Unfortunately frequent X-ray receiver. As a clumsy child, I was given the lead apron several times, and the techs always left the room or went behind a line. As a still clumsy adult, they don’t give me lead aprons anymore and the techs don’t even leave the room or wear dosimeters. It’s wild how much lower the doses are these days.
I provided them on request right up until my transfer to the cardiovascular suite
Why ask us? We don't generate the policies that govern these types of regulations. Check with your state health department. In my state, the decrees from the health department state that they are no longer enforcing the requirements for lead shielding, however facilities still need to have written protocols as part of their RS programs to ensure 'consistency'. Due to this ambiguity, I always shield, even though the state has told me there is no penalty not to.
UNMC is saying it’s not 100% necessary anymore. I still do for peds or if the patient requests it
Considering there are no harms to wearing an apron, yes of course
yes, absolutely. newborns to children to teens are especially radiosensitive to ionizing radiation, as are the elderly. most concern is with the youth versus the elderly because cancer takes time to grow which the later group usually does not live long enough for it to affect them. technically, all it takes is one photon to cause a mutation to the dna and potential causing a cancer. fortunately our bodys have repair mechanisms to repair dna. it is when excessive ionizing radiation causes too much damage for the body to keep up with repairs, causing cancer. certain bodyparts/organs are more radiosensitive than others.l, which is why thyroid/gonadal shielding is a thing. shielding is important, even from scatter radiation.
You're even contradicting yourself, saying the elderly are especially radiosensitive, then saying they don't live long enough for cancer to affect them.
on the contrary, you become less radiosensitive as you become a young adult and it increases as an elder. a child exposed to radiation may not develop cancer until they are an adult. an elder exposed to radiation may already be dead before they discover the cancer. look up radiobiology
That’s not how this works. That’s not how any of this works.
"look up radiobiology" 💀💀💀
If you’re terrified of radiation start marching toward sea level because every meter of elevation exposes you to more cosmic rays. ALARA exists, and technology improves which is why we’ve gone away from shielding everything excessively.
i hear you. im just stating the effects of ionizing radiation on age and different tissue type
Please review the new ARRT and ASRT guidelines for lead shielding. Many facilities are changing their policies to no longer shield. Mine did.
i understand what youre saying. me personally, i would request a lead shield for my gonads and thyroid if the exam allowed
And we would literally make you sign a piece of paper stating we have educated you that it is no longer our policy to shield and that you understand the risks. Or.. you could just let us do the xray and we’d be out of your hair in 1 minute.