Diagnostic Radiology and Imaging Services Patient Shielding Policy

Pediatric Radiology patient getting an X-ray

We are changing a decades' long policy of shielding patients with a lead apron during exams which utilize radiation, including X-rays. Patient lead shields were initially recommended during the 1950's when a study on fruit flies prompted concern that radiation might damage DNA and cause birth defects. During the past decade, prominent radiology and medical physics experts have researched and reassessed the practice of using lead shields. We now know much more about how radiation affects the human body and studies have shown that the effects of radiation on fruit flies do not correspond with its effect on humans or other animals. Today's equipment and technology also use much less radiation and operate more efficiently. In fact, some of the features of modern imaging equipment do not perform as intended when lead shielding is in the path of the beam. These advances in technology and knowledge have made patient shielding a practice that introduces more risk than benefit. This is true regardless of the patient’s age, sex, or pregnancy status. With advances in modern technology, and a better understanding of radiation, we are now aware that the practice of lead shielding does not benefit patients.

We understand that some patients have come to expect a lead apron during an x-ray, but impairing the quality of diagnostic tests for an outdated ritual is not supported by the medical advancements and is certainly not in the best interest of the patients. Some patients might be concerned with radiations effect on human organs. What we’ve learned is that, when the sensitive organs are far away from the part of the body being imaged, there is no benefit from using shielding. When the part of the body receiving x-rays is close to sensitive organs, a shield may cover up what doctors need to see, and even increase the radiation dose or the need to repeat the study.

As of November 1, 2020 OHSU will no longer use lead aprons on patients undergoing exams which utilize radiation.

More resources

Image of a downloadable patient flyer Diagnostic Radiology and Imaging Services Patient Shielding Policy

This is a change not only happening locally but in the radiology community at large. To help you gain a better understanding of this change, visit the American Association of Physicists in Medicine CARES page for the most in-depth and scientifically validated information. You can also read the Informational Bulletin regarding gonadal shielding issued by the Oregon Health Authority.

Below we have compiled a list of Frequently Asked Questions. If you have additional questions, the radiologic technologist performing your exam has more extensive knowledge and will be happy to answer your questions or direct you to medical physics resources, if needed.

We have a paper flyer that clinics can hand out to patients. Clinics can order printed flyers through the copy center.

General FAQs

Patient shielding was established more than 70 years ago. With advances in modern technology, and a better understanding of radiation, we are now aware that the practice of lead shielding does not benefit patients. We also know more about how radiation affects the human body. Some parts of the body - like the testicles and ovaries - are much less sensitive to radiation than we used to think. This is true regardless of the patient’s age, sex, or pregnancy status. There is also an added risk in using lead shielding, your exam could be compromised.

Since shielding a pregnant woman provides no benefit to the baby, it is best to not do it. We have equipment that can give us better information than ever before using very minimal radiation; however, placing shielding over a pregnant belly can reduce the quality of the exam if the shield gets into the image. In some cases, it could even increase the overall dose from the exam.

Since the 1950s, people were concerned that radiation might damage sperm or eggs and that this damage would be passed down to your future children. However, this has never been seen in humans, even after many generations of studying it closely. This is true even for people who have been exposed to much larger amounts of radiation than what is used in medical imaging.

It is necessary for your child to receive the x-ray; however, we ask that you wear a lead apron if you are in the room with them because there is no need for you to be exposed to any radiation. There is no risk that the lead apron you are wearing will negatively impact your child’s exam.

Absolutely. The universally accepted methods to control occupational radiation exposures are not impacted in any way by recommendations to discontinue the use of shielding on the patients. It is necessary for the patient to receive the x-ray, but it is not necessary for healthcare workers or assisting family to be exposed to scatter radiation from the patient. Personal protective devices such as lead aprons shall continue to be worn by medical professionals and family members who need to remain in the area during an x-ray.

At OHSU, we uphold that our clinical practices be based on the best and most recent scientific evidence. Although you expect to be shielded because it has been common practice for many decades, we now know the benefits from shielding are negligible, and that there is risk of compromising the exam. Medically and scientifically speaking, shielding is outdated.

Healthy cells have repair mechanisms to help protect them against small doses of radiation. There is continually-increasing scientific evidence that the risk from multiple exams is not cumulative.

Clinical practice should be based on the best and most recent scientific evidence. Although patients expect to be shielded because it has been common practice, the benefits from shielding are negligible,  and there is risk of compromising the exam. At OHSU, we uphold that our clinical practices be based on the best and most recent scientific evidence.

No, we do not use lead shielding during imaging exams. Medically and scientifically speaking, shielding is outdated. As with other areas of medicine, the use of patient shielding has been evaluated from a risk-benefit perspective. Shields may increase the exam’s radiation dose and cover up parts of your child’s body that your doctor needs to see. Since we have equipment that can give us better information using less radiation than in the past, shields are no longer beneficial and we have totally discontinued using them for all patients undergoing an imaging exam or procedure.

Radiologic Technologists and other Healthcare Professionals FAQ's

The American Association of Physicists in Medicine Communicating Advances in Radiation Education for Shielding (AAPM CARES) is an engaged community of stakeholders committed to communicating advances in radiation education. The committee includes members from over 14 professional organizations around the globe, representing medical and health physicists; radiologic technologists and organizations that oversee educational programs for radiologic technologists; radiologists; and state regulators. In April 2019, AAPM CARES announced their position that the use of patient shielding should be discontinued.

The most comprehensive explanation for this change of practices has been created by the CARES committee of the American Association of Physicists in MedicineThe change in practice is due to improvements in imaging technology and a better understanding of how radiation affects the body. Advances in medical imaging technology, such as better detectors, have greatly reduced the amount of radiation required to create a quality image. However, some of the features of modern imaging equipment (such as automatic exposure control) do not perform as intended when lead shielding is in the path of the beam. These advances have made patient shielding a practice that introduces more risk than benefit. This is true regardless of the patient’s age, sex, or pregnancy status. Collimation is still critical to ALARA and our current collimation standards will still be upheld.

Additionally, as with other areas of medicine, the use of patient shielding should be evaluated from a risk-benefit perspective. Many times when a shield is used, there is a risk that it will cover and obscure anatomy that could be important for an accurate diagnosis. Since shielding can introduce these risks and provides little or no benefit to the patient, we have discontinued using shields as part of routine practice.

In almost all cases, the amount of radiation used in medical imaging is several orders of magnitude lower than what is known to cause any harm to an unborn baby. Shields will not reduce the amount of radiation to the unborn baby, but may cover up parts of the body that the doctor needs to be able to see. The American College of Obstetricians and Gynecologists (ACOG) has a guideline that states: “With few exceptions, radiation exposure through radiography, computed tomography scan, or nuclear medicine imaging techniques is at a dose much lower than the exposure associated with fetal harm.” Even with a chest CT on a pregnant patient, the dose to the fetus is below 1 mGy, which is about the same as the dose a fetus gets from background radiation during gestation.

Gonadal shielding was introduced into clinical practice over 70 years ago.  Back then, it was believed that exposing the gonads to radiation could damage reproductive cells. However, these genetic effects have not been observed in humans, even three to four generations after the atomic bombings. As with other areas of medicine, the use of patient shielding should be evaluated from a risk-benefit perspective. For example, any time a shield is used, there is a risk that it will cover and obscure anatomy that could be important for an accurate diagnosis. Since shielding can introduce these risks and provides little or no benefit to the patient, we have discontinued using shields as part of routine practice.

Clinical practice should be based on the best and most recent scientific evidence. Although patients expect to be shielded because it has been common practice for many decades, we should explain to the patient that the benefits from shielding are negligible, and that there is risk of compromising the exam. In most situations, it is most appropriate for the technologist to explain why shielding is not recommended. If the patient or parent continues to insist that shielding be used, the technologist will provide the patient literature to further assure them it is safe to move forward with the exam. As always, with some patients, it is especially important for the patient’s nurse and provider team to emphasize the importance of the exam.

Gonadal shielding was introduced into clinical practice over 70 years ago. Back then, it was believed that exposing the gonads to radiation could damage reproductive cells. However, these genetic effects have not been observed in humans, even three to four generations after the atomic bombings. In almost all cases, the amount of radiation used in medical imaging is several orders of magnitude lower than what could potentially cause harm to an unborn baby. Shields will not reduce the amount of radiation to the unborn baby, but may cover up parts of the body that the doctor needs to be able to see. The American College of Obstetricians and Gynecologists (ACOG) has a guideline that states: “With few exceptions, radiation exposure through radiography, computed tomography scan, or nuclear medicine imaging techniques is at a dose much lower than the exposure associated with fetal harm.” Even with a chest CT on a pregnant patient, the dose to the fetus is below 1 mGy, which is about the same as the dose a fetus gets from background radiation during gestation.

This is from radiation scattered within the patient, before reaching parts of the detector that are outside of the field of view. We can see these regions on images only because modern X-ray detectors are so sensitive. This very small amount of radiation outside the field of view is not justification for shielding patients.

Absolutely. The universally accepted methods to control occupational radiation exposures are not impacted in any way by recommendations to discontinue the use of shielding on the patients. It is necessary for the patient to receive the x-ray, but it is not necessary for healthcare workers to be exposed to scatter radiation from the patient. Personal protective devices such as lead aprons should be worn by medical professionals and family members who need to remain in the area during an x-ray.