Have RT’s forgotten and forgone their shielding policies in lieu of the recent debate?
It’s been almost five years since the shielding debate began about gonadal shielding. I wrote my first blogs in January and February, 2018. ASRT published their white paper on the subject on July 2, 2019. Then the NCRP issued a statement regarding what they interpreted the shielding requirements to state. Last month many educators raised the question about what happened in actual clinical practice after the debate subsided. Is there a state of mass confusion or a mass of misunderstanding? Some educators were reporting cases of confusion from students in the clinical setting who had been told they could not shield at all.
Some State Agencies have responded by changing regulations and other states have made no changes. Educators state that it is very difficult to “unteach” something that has been a standard in our education for so long. Others are questioning why education is so important if radiation is no longer harmful and shielding is not required. These are excellent questions and AHEC decided to ask our readers what their current practice is in the “real world of patient care”.
We sent a survey monkey questionnaire to ask about real world practice in the area of shielding. Our respondents told us their type of practice settings were 25% rural, 34% suburban, 28% urban, and 12% megatropolis. We also asked the type of healthcare facility where they practiced. We had 11% in hospitals outpatient and 11% in inpatient departments with 34% assigned to include both areas. The physician or family practice clinics were practice sites for 10%. The outpatient imaging centers were listed at 23% and the category for others was 11%. Respondents from 15 states participated in the survey.
The results below show the responses to the survey and the percentage of each category and the answers. The responses seem to show that not much has changed in five years regarding shielding practice in clinical application.
Some respondents left comments at the completion of the survey which express attitudes toward the changes and that consensus does not exist in many of the practicing clinical radiologic technologists.
This survey does ask some of the questions about shielding and they were answered by current clinical radiologic technologists. Comments from respondents pertinent to the issue are listed below. They are representative of prevalent attitudes among practicing radiographers.
“Shielding is vital for all patient, regardless the age and follow ALARA.”
“Doing mammography, we still use the thyroid shield when pt’s ask for one.”
“Some seem to have misunderstood original intent; which I believe was supposed to just take out shielding for gonads only when they are in the field of view like for pelvis and abdomen. I believe many have taken this out of context and have made up their own rules about the issue.”
“I was also confused about research provided regarding shielding pregnant women.”
“Shield as you find appropriate better to err on side of caution than cause harm you don’t realize.”
“I have read articles by physicians that shielding gonads was no longer necessary as long as beam is collimated to body part. State inspector’s claimed standing 6 < 8 feet away from the patient would limit any tech exposure for mobile exams. I must admit that my employee radiation monitor reflects that this is correct. I do stand behind a door if possible. WE still shield pregnant mothers if possible and wrap around lead aprons for minor CT exams. MFG of equipment claim the digital world greatly reduces dose and collimation reduces also.”
“Mammography related. No shielding of women under 40 yrs. of age due to lower dose of New Tomo units.”
“I have practiced shielding my whole career (46 years). I’m not so easily swayed to change that practice overnight.”
“Many have discontinued use of shielding on all exams and patients due to “recommendations”.”
“I believe that shielding patients is still a concern and committed to do so when the need arises.”