When should gonadal shielding be used on a patient?

1. Khong P-L., Ringertz H., Donoghue V., Frush D., Rehani M., Appelgate K., Sanchez R. ICRP Publication 121: Radiological Protection in Paediatric Diagnostic and Interventional Radiology. Annals of the ICRP. 2013;42(2):1–63. doi: 10.1016/j.icrp.2012.10.001. [PubMed] [CrossRef] [Google Scholar]

2. IAEA (2018) Radiation protection and safety in medical uses of ionizing radiation. International Atomic Energy Agency, Vienna

3. NVMBR (2017) Richtlijn Gonadenafscherming voor conventionele radiologie en CT. Utrecht. Available via https://www.nvmbr.nl/publicatiebestanden/NVMBR%20Richtlijn%20Gonadenafscherming%20mei%202017.pdf

4. Marsh Rebecca M., Silosky Michael. Patient Shielding in Diagnostic Imaging: Discontinuing a Legacy Practice. American Journal of Roentgenology. 2019;212(4):755–757. doi: 10.2214/AJR.18.20508. [PubMed] [CrossRef] [Google Scholar]

5. AAPM (2019) AAPM Position Statement on the Use of Patient Gonadal and Fetal Shielding PP32-A. Available via https://www.aapm.org/org/policies/details.asp?id=468&type=PP

6. Fawcett S L, Gomez A C, Barter S J, Ditchfield M, Set P. More harm than good? The anatomy of misguided shielding of the ovaries. The British Journal of Radiology. 2012;85(1016):e442–e447. doi: 10.1259/bjr/25742247. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

7. Frantzen Marij J., Robben Simon, Postma Alida A., Zoetelief Johannes, Wildberger Joachim E., Kemerink Gerrit J. Gonad shielding in paediatric pelvic radiography: disadvantages prevail over benefit. Insights into Imaging. 2011;3(1):23–32. doi: 10.1007/s13244-011-0130-3. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

8. Warlow T, Walker-Birch P, Cosson P. Gonad shielding in paediatric pelvic radiography: Effectiveness and practice. Radiography. 2014;20:178–182. doi: 10.1016/j.radi.2014.01.002. [CrossRef] [Google Scholar]

9. Lee MC, Lloyd J, Solomito MJ. Poor utility of gonadal shielding for pediatric pelvic radiographs. Orthopedics. 2017;40:e623–e627. doi: 10.3928/01477447-20170418-03. [PubMed] [CrossRef] [Google Scholar]

10. Strauss KJ, Gingold EL, Frush DP. Reconsidering the value of gonadal shielding during abdominal/pelvic radiography. J Am Coll Radiol. 2017;14:1635–1636. doi: 10.1016/j.jacr.2017.06.018. [PubMed] [CrossRef] [Google Scholar]

11. Kumar A., Chau W. W., Hung A. L.-H., Wong J. K.-T., Ng B. K. W., Cheng J. C. Y. Gonadal shield: is it the Albatross hanging around the neck of developmental dysplasia of the hip research? Journal of Children's Orthopaedics. 2018;12(6):606–613. doi: 10.1302/1863-2548.12.180133. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

12. Karami V, Zabihzadeh M, Shams N, Sarikhani S. Evaluation of the prevalence and utility of gonad shielding in pediatrics undergoing pelvic X-ray. Int J Pediatr. 2016;4(11):3735–3740. [Google Scholar]

13. Kaplan Summer L., Magill Dennise, Felice Marc A., Xiao Rui, Ali Sayed, Zhu Xiaowei. Female gonadal shielding with automatic exposure control increases radiation risks. Pediatric Radiology. 2017;48(2):227–234. doi: 10.1007/s00247-017-3996-5. [PubMed] [CrossRef] [Google Scholar]

14. Marcuse W. Nachtrag zu dem Fall von Dermatitis und Alopecie nach Durchleuchtungsversuchen mit Röntgenstrahlen. Dtsch Med Wochenschr. 1896;22:481–483. doi: 10.1055/s-0029-1204573. [CrossRef] [Google Scholar]

15. Hönigsmann H. History of phototherapy in dermatology. Photochem Photobiol Sci. 2013;12:16–21. doi: 10.1039/C2PP25120E. [PubMed] [CrossRef] [Google Scholar]

16. Williams FH. The roentgen rays in medicine and surgery. New York: The Macmillan Company; 1901. [Google Scholar]

17. HYDE JAMES NEVINS. A CONTRIBUTION TO THE SUBJECT OF RADIOTHERAPY AND PHOTOTHERAPY IN CARCINOMA, TUBERCULOSIS AND OTHER DISEASES OF THE SKIN. JAMA: The Journal of the American Medical Association. 1903;XL(1):1. doi: 10.1001/jama.1903.92490010001001. [CrossRef] [Google Scholar]

18. Bullitt JB (1905) Comparison of Röntgen-ray and surgical treatment of tuberculosis. Trans Am Röntgen Ray Soc. (Fifth annual meeting, St Louis), p 26–34

19. Pennington JR. Roentgen rays in the treatment of pruritis ani. N Y Med J Phila Med J. 1904;89:356–358. [Google Scholar]

20. Brown FT, Osgood AT. X-rays and sterility. Am J Surg. 1905;18:179–182. [Google Scholar]

21. Despeignes V (1896) Observation concernant un cas cancer de l’estomac, traités par les rayons röntgens. Lyon Méd J 82:428–430

22. Albers-Schönberg HE (1903) Ueber eine bisher unbekannte Wirkung der Röntgenstrahlen auf den Organismus der Tiere. Muench Med Wochenschr 50:1859–1860

23. Halberstaedter L. Die Einwirkung der Röntgenstrahlen auf Ovarien. Berl Klin Wochenschr. 1905;42:64–66. [Google Scholar]

24. Bardeen CR. Abnormal development of toad ova fertilized by spermatozoa exposed to the Roentgen rays. J Exp Zool. 1907;4:1–44. doi: 10.1002/jez.1400040102. [CrossRef] [Google Scholar]

25. Muller HJ. Artificial transmutation of the gene. Science. 1927;66:84–87. doi: 10.1126/science.66.1699.84. [PubMed] [CrossRef] [Google Scholar]

26. Mavor JW. On the Elimination of the X-chromosome from the egg of Drosophila melanogaster by X-rays. Science. 1921;54:277–279. doi: 10.1126/science.54.1395.277. [PubMed] [CrossRef] [Google Scholar]

27. Witte E. Welche Mittel gibt es, um bei diagnostischer Verwendung der Röntgenstrahlen die Dosis zu vermindern? Fortschritte auf dem Geb Röntgenstrahlen. 1933;47:312–321. [Google Scholar]

28. Neeff TC. Über Strahlendosen bei der Röntgenkymographie in der Schwangerschaft. Fortschritte auf dem Geb Röntgenstrahlen. 1934;50:86–90. [Google Scholar]

29. Zimmer KG. Über Dosismessungen während Röntgendiagnostik. Fortschritte auf dem Geb Röntgenstrahlen. 1935;51:418–421. [Google Scholar]

30. Griffith HD, Zimmer KG. The time-intensity factor in relation to the genetic effects of radiation. Br J Radiol. 1935;8:40–47. doi: 10.1259/0007-1285-8-85-40. [CrossRef] [Google Scholar]

31. Pickhan A. Welche Strahlendosen dürfen bei der Röntgendiagnostik der weiblichen Zeugungsorgane nach den Ergebnissen der experimentellen Strahlengenetik in erbbiologischem Sinne als unschädlich betrachtet werden? Fortschritte auf dem Geb Röntgenstrahlen. 1936;53:901–904. [Google Scholar]

32. ICRP (1959) 1958 Recommendations of the International Commission on Radiological Protection. Ann ICRP 1(1), iii–x

33. UNSCEAR (1958) UNSCEAR. General Assembly. Official Records. Thirteenth session. Supplement No17 (A3838). New York

34. ICRP (1970) Protection of the patient in X-ray diagnosis. ICRP Publication 16. Pergamon Press, Oxford

35. ICRP (2007) The 2007 Recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann ICRP 37 (2-4). [PubMed]

36. Frik W (1960) Gesamtbelastung als Maß für die Strahlengefährdung. Röntgen-Bl 13:166–172

37. ICRP Recommendations of the ICRP. ICRP Publication 26. Ann. ICRP. 1977;1(3):1–53. doi: 10.1016/0146-6453(77)90001-X. [CrossRef] [Google Scholar]

38. ICRP (1991) 1990 Recommendations of the International Commission on Radiological Protection. ICRP Publication 60. Ann ICRP 21 (1-3). [PubMed]

39. Holzknecht G, Grünfeld R. Ein neues Material zum Schutz der gesunden Haut gegen Röntgenlicht und über radiologische Schutzmassnahmen im Algemeinen. Münch Med Wochenschr. 1903;50:1202–1205. [Google Scholar]

40. Cramer M. Über die Behandlung der Leukämie mit Röntgenstrahlen. Fortschritte auf dem Geb Röntgenstrahlen. 1905;9:115–117. [Google Scholar]

41. Kienböck R. Radiotherapie. Stuttgart: Ferdinand Enke; 1907. [Google Scholar]

42. Albers-Schönberg H, Walter B. Die Röntgentechnik, third. Hamburg: Lucas Gräfe & Sillem; 1910. [Google Scholar]

43. Albers-Schönberg (1941) Die Röntgentechnik, 6th ed. Georg Thieme, Leipzig

44. ICRP (1955) Supplement No. 6. Recommendations of the International Commision on Radiological Protection. Br J Radiol 1–92

45. Kriser A. Einige technische Verbesserungen bei der Tiefenbestrahlung - Behelfe und Schutzvorrichtungen bei Bestrahlung der Keimdrüsen und ihrer Umgebung. Verhandlungen Dtsch Röntgen-Ges. 1923;14:115–118. [Google Scholar]

46. Magnusson W. A device for the protection of the testicle in roentgen examinations of adjacent organs and bones. Acta Radiol. 1952;37:288–290. doi: 10.1177/028418515203700321. [PubMed] [CrossRef] [Google Scholar]

47. Lorenz W. Physikalisch-technische Probleme des Strahlenschutzes in medizinische Anlagen. Fortschritte auf dem Geb Röntgenstrahlen. 1958;88:251–276. doi: 10.1055/s-0029-1226032. [PubMed] [CrossRef] [Google Scholar]

48. Ardran GM, Kemp FH. Protection of the male gonads in diagnostic procedures. Br J Radiol. 1957;30:280–280. doi: 10.1259/0007-1285-30-353-280. [PubMed] [CrossRef] [Google Scholar]

49. Stieve FE. Untersuchungen über Maßnahmen zur Reduzierung der Strahlenbelastung der männlichen Keimdrüsen bei röntgendiagnostischen Maßnahmen in deren Umgehung. Fortschritte auf dem Geb Röntgenstrahlen. 1959;90:373–386. doi: 10.1055/s-0029-1226296. [PubMed] [CrossRef] [Google Scholar]

50. Abram E, Wilkinson DM, Hodson CJ. Gonadal Protection from X radiation for the Female. Br J Radiol. 1958;31:335–336. doi: 10.1259/0007-1285-31-366-335. [PubMed] [CrossRef] [Google Scholar]

51. Krepler P, Vana N, Havranek C (1977) Dosimetric studies in the radiological examination of the hips in young infants with a special fenestration method of gonad protection. Pediatr Radiol 5:231–235 [PubMed]

52. Hodges PC, Strandjord NM, McCrea A. A testicular shield. J Am Med Assoc. 1958;167:1239. doi: 10.1001/jama.1958.72990270008009b. [PubMed] [CrossRef] [Google Scholar]

53. Whitehead G, Griffiths JT. The Leicester gonad protector: a device to afford localised protection from diagnostic x irradiation. Br J Radiol. 1961;34:135–136. doi: 10.1259/0007-1285-34-398-135. [PubMed] [CrossRef] [Google Scholar]

54. Correll R, Plischke U, Dresel H, Joos M. Gonadenschutz bei Beckenaufnahmen. Röntgen-Bl. 1976;29:137–142. [PubMed] [Google Scholar]

55. Büchner H, Wendrich G. Über einen neuen variablen Ovarienschutz bei Röntgenaufnahmen des Beckens. Röntgen-Bl. 1963;16:385–394. [Google Scholar]

56. Markó D. Gonadenschutz (Gonad-Defensor), ein Tubus für Beckenaufnahmen. RöFo - Fortschritte auf dem Geb Röntgenstrahlen Bildgeb Verfahr. 1962;97:793–796. doi: 10.1055/s-0029-1227140. [CrossRef] [Google Scholar]

57. Grigg ERN (1965) The trail of the invisible light. From X-Strahlen to Radio(bio)logy. Charles C. Thomas, Springfield, USA

58. Yousefzadeh DK, Ward M, Reft C, Pelizzari C (2006) Methods of attenuating internal radiation exposure. US patent 2006/0009694 A1. https://patentimages.storage.googleapis.com/9d/d3/ea/ee7ae848835a9c/US20060009694A1.pdf.

59. ICRP (1982) Protection of the patient in diagnostic radiology. ICRP Publication 34. Ann ICRP 9 (2-3) [PubMed]

60. Karami V, Zabihzadeh M, Shams N, Saki Malehi A. Gonad shielding during pelvic radiography: a systematic review and meta-analysis. Arch Iran Med. 2017;20:113–123. [PubMed] [Google Scholar]

61. Kemerink GJ, Kütterer G, Kicken PJ, van Engelshoven JMA, Simon KJ, Wildberger JE (2019) The skin dose of pelvic radiographs since 1896. Insights Imaging 10:39 10.1186/s13244-019-0710-1 [PMC free article] [PubMed]

62. Tapiovaara M, Siiskonen T (2008) Report - PCXMC: a Monte Carlo program for calculating patient doses in medical x-ray examinations, 2. ed. STUK, Helsinki

63. Tapiovaara M, Siiskonen T. PCXMC: a Monte Carlo program for calculating patient doses in medical x-ray examinations. STUK - Radiation and Nuclear Safety Authority: Helsinki; 2008. [Google Scholar]

64. Beck C. Röntgen ray diagnosis and therapy. New York: D. Appleton and company; 1904. [Google Scholar]

65. Biddle JG (1904) Roentgen induction coils and other X-ray apparatus. James G Biddle, Philadelphia

66. Biddle JG (1905) Typical “Roentgen” Equipments. James G Biddle, Philadelphia

67. Albers-Schönberg, (1906) Die Röntgentechnik: Lehrbuch für Ärzte und Studierende, second. Lucas Gräfe & Sillem, Hamburg

68. Janker HC (1958) Röntgen-Aufnahmetechnik. Teil I: Einstellungen. Johann Ambrosius Barth, München

69. Lincoln A, Gupton ED. Radiation dose to gonads from diagnostic x-ray exposure. J Am Med Assoc. 1958;166:233–239. doi: 10.1001/jama.1958.02990030031007. [PubMed] [CrossRef] [Google Scholar]

70. European Commission, Directorate-General for Energy (2015) Diagnostic Reference Levels in Thirty-six European Countries. RP 180 -Part 2/2. Publications Office, Luxembourg

71. RIVM (2015) Vervolgproject DRN toetsing:2015 https://www.rivm.nl/medische-stralingstoepassingen/stralingsbescherming-pati-nten/diagnostische-referentieniveaus/vervolgproject-drn-toetsing-2015.

72. RIVM (2016) Vervolgproject DRN toetsing:2016 https://www.rivm.nl/medische-stralingstoepassingen/stralingsbescherming-pati-nten/diagnostische-referentieniveaus/vervolgproject-drn-toetsing-2016.

73. RIVM (2017) Vervolgproject DRN toetsing:2017 https://www.rivm.nl/medische-stralingstoepassingen/stralingsbescherming-pati-nten/diagnostische-referentieniveaus/vervolgproject-drn-toetsing-2017.

74. Bijwaard H, de Vries G, Scheurleer J, et al. Compliance to Diagnostic Reference Levels for radiation exposure in common radiological procedures in Dutch hospitals: A nation-wide survey carried out by medical imaging students. Radiography. 2017;23:197–201. doi: 10.1016/j.radi.2017.03.005. [PubMed] [CrossRef] [Google Scholar]

75. Martin C (2007) The importance of radiation quality for optimisation in radiology. Biomed Imaging Interv J 3(2) 10.2349/biij.3.2.e38 [PMC free article] [PubMed]

76. Kawashima H, Ichikawa K, Nagasou D, Hattori M. X-ray dose reduction using additional copper filtration for abdominal digital radiography: Evaluation using signal difference-to-noise ratio. Phys Med. 2017;34:65–71. doi: 10.1016/j.ejmp.2017.01.015. [PubMed] [CrossRef] [Google Scholar]

77. European Commission, Directorate-General for Energy (2015) Medical radiation exposure of the European population. RP 180 - Part 1/2. Publications Office, Luxembourg

78. Völk M, Hamer OW, Feuerbach S, Strotzer M. Dose reduction in skeletal and chest radiography using a large-area flat-panel detector based on amorphous silicon and thallium-doped cesium iodide: technical background, basic image quality parameters, and review of the literature. Eur Radiol. 2004;14:827–834. doi: 10.1007/s00330-004-2243-2. [PubMed] [CrossRef] [Google Scholar]

79. Health Consumer Powerhouse (2017) Euro Health Consumer Index:2017 https://healthpowerhouse.com/media/EHCI-2017/EHCI-2017-report.pdf.

80. Wall BF, Haylock R, Jansen JTM, Hillier MC, Hart D, Shrimpton PC (2011) Radiation risks from medical x-ray examinations as a function of the age and sex of the patient. Centre for Radiation, Chemical and Environmental Hazards, Health Protection Agency

81. ICRP (1966) Recommendations of the International Commission on Radiological Protection. ICRP Publication 9. Pergamon Press, Oxford

82. ICRP (1973) Implications of Commission Recommendations that doses be kept as low as readily achievable. ICRP Publication 22. Pergamon Press, Oxford.

83. ICRP Radiological Protection and Safety in Medicine. ICRP Publication 73. Ann. ICRP. 1996;26(2):1–47. doi: 10.1016/S0146-6453(00)89195-2. [PubMed] [CrossRef] [Google Scholar]

84. ICRP (2001) Diagnostic Reference Levels in medical imaging: review and additional advice. ICRP Supporting guidance 2. Ann ICRP 31:33–52 [PubMed]

85. Vañó E., Miller D.L., Martin C.J., Rehani M.M., Kang K., Rosenstein M., Ortiz-López P., Mattsson S., Padovani R., Rogers A. ICRP Publication 135: Diagnostic Reference Levels in Medical Imaging. Annals of the ICRP. 2017;46(1):1–144. doi: 10.1177/0146645317717209. [PubMed] [CrossRef] [Google Scholar]

86. European Union (2014) Council Directive 2013/59/Euratom of 5 December 2013 laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation (L 13). Off J Eur Union 57:1–73

87. ESR Eurosafe Imaging website. http://www.eurosafeimaging.org/. Accessed 27 Nov 2019

88. European Society of Radiology (ESR) The Current Status of Uptake of European BSS Directive (2013/59/Euratom) Requirements – Results of a Pilot Survey in European Radiology Departments with a Focus on Clinical Audit. Insights Imaging. 2019;10:50. doi: 10.1186/s13244-019-0734-6. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

89. Schegerer A, Loose R, Heuser LJ, Brix G. Diagnostic Reference Levels for Diagnostic and Interventional X-Ray Procedures in Germany: Update and Handling. RöFo - Fortschritte auf dem Geb Röntgenstrahlen Bildgeb Verfahr. 2019;191:739–751. doi: 10.1055/a-0824-7603. [PubMed] [CrossRef] [Google Scholar]

90. Gürsu Sarper. Efficacy of gonadal shielding in pediatric pelvis X-rays. Joint Diseases and Related Surgery. 2013;24(2):87–90. doi: 10.5606/ehc.2013.20. [PubMed] [CrossRef] [Google Scholar]

91. Valentin J. ICRP 99. Low-dose extrapolation of radiation-related cancer risk. Ann ICRP. 2005;35:1–140. [PubMed] [Google Scholar]