To X-ray Shield or Not – Listen to Your Patients

Whitney J. Palmer

While the opinion is growing that X-ray shielding for gonads isn’t necessary, some patients may still be concerned and request it.

Radiation exposure can be a scary thing for patients – especially when the scans impact their reproductive organs. Radiologists and radiology technologists, however, can play an active role in helping assuage patient fears.

The use of lead shielding, once the standard, is now questionable, so are you ready to address patient questions about whether to use it? In an opinion article published June 2 in the Journal of the American College of Radiology, Baylor College of Medicine radiologist Richard Strax, M.D., and CHI Baylor St. Luke’s Medical Center radiology technologist Ernest Molina, RT(R)(CT) share their insights into alleviating patient worries and fears.

“Your job is to educate and reassure them and be certain that they are comfortable with the process,” Strax and Molina wrote. “Keeping a discussion about shielding centered on the needs of the patient, and providing education with science at its foundation, adds value to patient care and puts the radiology technologist and radiologist at the forefront [of] the clinical team.”

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The utility of lead shielding for the gonads during X-rays scans has been a subject of debate for decades. In 2019, the American Association of Physicists in Medicine, supported by the American College of Radiology and the Radiological Society of North America, announced that such shielding should be discontinued. Still, other organizations, including the World Health Organization and the International Commission on Radiological Protection, continue to support it.

With these mixed messages – and with there being no standardized lead shielding policy across all radiology departments and practices – how should you handle patient concerns when they’re presented? Strax and Molina offered this guidance:

Educate your staff: Know the shielding policies of your institution and your state, as well as the radiation dose associated with your equipment. Be sure both technologists and radiologists are armed with these facts and trained well to respond patiently and compassionately to concerns. And, if your facility does require shielding, make sure your technologists know how to position the shields correctly.

Listen: Listen carefully to your patient’s concern, and do not assume you fully understand their beliefs or fears. Be cognizant that the patient’s perception of risk – correct or not – can play a substantial role in their thoughts and decisions about shielding.

“Ask about their concerns and listen carefully,” Strax wrote. “Reassure patients that we take those concerns seriously, and that we always consider the benefits and risks of what we do.”

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Explain the procedure: Technologists should explain planned procedures to patients, including medical necessity and the precautions that are taken to keep dose for X-ray scans as low as possible. In addition, Molina said, have a visual aid that can help you explain radiation dose to your patients.

“I carry with me a table of safe radiation reference levels, and I can show patients that their specific radiation dose, or that of their child, is well within those levels,” he wrote. “I like to use my table of safe doses along with a snapshot from the estimated dose on the scanner. This shows patients that the amount of radiation used for their scan is lower than the acceptable levels allowed.”

Individualize your response: There is no cookie-cutter way to address every patient’s concern. Tailor your response to their specific questions about radiation dangers and shielding, and use lay language with your explanations. Keep your attention focused on the patient, and do not be overly insistent or intimidating. In addition, don’t expect to allay fears with specifics about physics and dose levels, but have that information at the ready in case patients have questions about your equipment.

Overall, Strax said, your job is to make the patient as comfortable with the process as possible, even if it means, in some cases, using shielding when you think it might be an unneeded precaution.

“Ultimately, if you feel shielding is unnecessary, but a patient continues to insist on shielding, and if it will not adversely affect the examination, provide the shield so that the procedure can be completed,” he said. “The greatest harm will be done if they become uneasy and refuse a necessary examination simply because you were too busy or frustrated to put them at ease.”

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