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Modern Radiation Protection Practices

By Beth Allen

I am the director of clinical operations for Banner Imaging in Phoenix, Arizona. I am honored to be able to be a regular contributor to this publication that has become a resource for imaging professionals. I began my radiology career in 1985 at a VA hospital in Fargo, North Dakota. I left the cold weather a few years later and moved to Arizona. I crossed trained into CT and eventually moved into management about five years ago. I share this information not only to introduce my background, but to illustrate how long I have been in radiology and how things have changed.

In April of 2019, the American Association of Physicists in Medicine (AAPM) released a position statement that updated the recommendations regarding the routine use of fetal and gonadal shielding for medical imaging. The previous practice recommendations had not changed for many years. I recall how much this shielding was emphasized during my training. Proper shielding was a required part of each exam that we were graded on.

According to the latest information provided by the AAPM, gonadal shielding is no longer necessary and may do more harm than good. During the AHRA Virtual Annual Meeting in August, I attended a flash session that laid out the reasons these recommendation changes occurred.

The practice of gonadal shielding for children and patients of childbearing age was introduced over 70 years ago. The beliefs regarding harm to a patient’s future children or infertility have not proven true. Shielding will not eliminate exposure caused by scatter radiation and if the shield is not in the correct location, it can obscure anatomy necessary to diagnosis. Due to advances in technology, the radiation required to produce an image is greatly reduced to the point that it may not be enough to affect the body at all.

Through the years, the practice of fetal and gonadal shielding has not changed much. It is what patients have come to expect. With this change in philosophy from the AAPM, our technologist can expect to get questions regarding this change in practice and we should be prepared to deliver answers that will educate our patients and put them at ease.

These recommendations have been endorsed by the ACR, Image Gently and physicist groups across the world. This effort has been dubbed CARES – Communicating Advances in Radiation Education for Shielding. A committee was formed to publish a list of FAQs and suggested talking points for health care professionals, patients, and parents and guardians. The CARES team has indicated that if not using shielding would result in the patient refusing the exam, we should use it.

Old habits die hard. Technologists and patients alike may feel uneasy accepting this new information. It is similar to when we were told that we no longer needed to ask patients if they were allergic to shellfish. At first, it was difficult to trust that this was going to be alright and there was no correlation to the contrast and shrimp. Eventually, we got over it.

Every so often, there is a story in the media regarding radiation exposure for patients. It may be on the news or Dr. Oz. Often the media uses examples from exposure to victims of the atomic bomb. This can increase the number of questions we receive. Radiation exposure from medical imaging has made incredible advances. We have adopted the ALARA principle and technology has focused on reduced radiation exposure for the last 20 years. Digital radiology and advancements in CT have changed the way we image.

We still need to be responsible in the way we utilize medical imaging. Referring physicians weigh risk verses benefit for our patients; radiologists guide our protocols; and technologists strive to be accurate and efficient in producing images. As professionals, it is expected that we have the latest information regarding radiation safety and protection. I encourage you to share this information with your team. It will be up to us to educate our communities on the positive changes that have occurred within our profession and make them feel safe.

I appreciate the opportunity to share my thoughts and ideas in this column. We have a talented team of imaging professionals at Banner Imaging that I will tap for expertise and collaboration to keep this timely and relevant.

My days are filled with adapting to all the changes that are thrown our way. Health care will never be the same. We bob and weave to take care of our patients and our teams. Through all the turbulence, we find new ways to improve and excel. Not to mention, we try to enjoy ourselves along the way.

I wish I had a witty tagline to close this column, but for now I will just ask you to take care of yourself and each other.

Beth Allen, RT(R)(CT) CRA, is the director of clinical operations at Banner Imaging.

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