We are discussing whether we should protect infants from unintentional (primary) radiation, using gonadal shields during chest x-rays. Currently, we do not use such shields.

This interesting article was published in Journal of Perinatology (see abstract below)

OBJECTIVE: To evaluate the extent of unintentional exposure to X-rays performed during routine diagnostic procedures in the Neonatal Intensive Care Units (NICUs).

STUDY DESIGN: During a 1-month period, 157 consecutive neonates from five level-III NICUs were recruited for this study. The mean birth weight was 1747+/-911 g (range: 564-4080 g), and gestational age was 31.6+/-3.6 weeks (range: 24-41 weeks). A total of 500 radiographs were performed including chest (68%), abdomen (17%) and combined chest and abdomen (15%). The average number of radiographs taken per infant was 4.2+/-3.6 (range: 1-21). Unintentional inclusion of body regions other than those ordered was determined by comparing the areas that should be included in the radiation field according to International recommendations, to those that appeared in the actual radiograph.

RESULT: A comparison of the recommended borders to the actual boundaries of the radiographs taken show an additional exposure to radiation in all three procedures: 85% of chest radiographs also included the whole abdomen, 64% of abdomen radiographs included both thigh and upper chest and 62% of chest and abdomen radiograph included the thigh. (The range in all procedures was from ankle to upper head.) Between 2 and 20% of the relevant targeted body tissues were not included in the exposed fields resulting in missing data. The gonads of both sexes were exposed in 7% in all chest X-rays. Among male infants, the testes were exposed in 31% of plain abdomen radiographs and 34% of chest and abdomen radiographs.

CONCLUSION: In the NICUs participating in the study, neonates are currently being exposed to X-ray radiation in nonrelevant body regions. Higher awareness and training of the medical teams and radiographers are required to minimize unnecessary exposure of newborns to ionizing radiation.

Pubmed-link: http://www.ncbi.nlm.nih.gov/pubmed/17625572

Would be interested to hear your opinions and experiences on this topic.

Hi all!

We do actually use gonadal shields during chest x-ray. We haven`t done that a long time but since i took a course about radiation and based on that information, I learned that we should use shields with every patient.

Earlier (when we didn`t know better) we used shields on the roof of the incubator (this was sometimes, not always), but as the radiation spreads horizontally when it "touches" the patient, we started to put the shield direct upon the pelvis.

We also mark in the Clinisoft -system (which is our intensive care patient -system) every x-ray we take, so that it is possible to find out later (if needed) how much radiation the patient has got in the past.

BR,

Johanna from Finland

RN

Tampere University Hospital

Johanna, interesting policy!

Where did you get those shields from?

Can you post some technical details (size, weight etc) and maybe photos?!

I have been a NICU nurse in Virginia in the USA for 20 years in a Level 3 nursery and have always used lead shields for xrays on babies. I find it interesting that so far 75% don't that have responded to your survey.

...have always used lead shields for xrays on babies...

Did/do you buy those shields from somewhere, or are they "home-made"?

Could you post a photo?

Hi

Any evidence for using this shields?

Here are some pictures about the shields we use in Finland. The purple ones are new and every patient has one of these by his/her side. They are re-useable. These are easy to use and easy to remember when it`s placed by every patient. The blue one is older model and we don`t use these so often anymore.

Found one place from the internet who sells shields for the prematures: www.natus.com.

BR,

Johanna from Finland

I work in a Level 3 nursery in the Midwest and we try our best to use gonadal shields on chest xrays. They are heart shaped. Point up for males and point down for females.