How to discuss routine X-ray shielding with patients: 2 views

Routine patient shielding during X-ray exams has morphed from an unremarkable habit into one of radiology’s most controversial topics.

The practice started as a safety measure in 1905 and soon became a standard operating procedure. Only recently has it been called in for serious questioning as some leading imaging groups have aligned against it. In 2019, for example, the American Association of Physicists in Medicine said gonadal and fetal shielding should be discontinued, a stance supported by the American College of Radiology.

Shortly after the announcement, the American Society of Radiologic Technologists said it could not endorse the proposal. Some providers have also warned that eliminating the practice may increase “radiophobia.”

The pandemic has further complicated matters, with some large systems ditching lead aprons to eliminate infection risks.

So how should providers respond if a worried patient insists on shielding?

Wednesday in JACR, Richard Strax, MD, a radiologist with Baylor College of Medicine, and Ernest Molina, a radiologic technologist at CHI Baylor St. Luke’s Medical Center, called for empathy and common sense.

Technologist advice

Technologists are likely first to face patient questions about shielding and must understand departmental policies and guidelines, along with shielding facts, Molina explained.

Listen to requests and concerns, Molina urges. Scanner-specific dose sheets and information from the ACR can help ease anxieties.

“I do everything I can to explain to the patients why shielding may not be used as it once was,” Molina explained. “If I cannot answer their questions or they are still unsure if they need it or want it, I will bring in the radiologist.”

Radiologist guidance

Patients’ perception of X-ray radiation risk may lead many to insist on shielding, Strax cautioned, and it's crucial to consider their emotions before responding.

Let individuals know there are no known harmful effects but the process still minimizes exposure to reduce any theoretical risk. Physics and dose levels won’t reassure most; be sure to use lay language.

Ultimately, Strax emphasized, patients are at the center of medicine and radiologists need to work to ensure they’re comfortable. The worst case is if they refuse a necessary exam. If a patient insists on shielding, provide it to complete the procedure.

Incorporating all these factors into the shielding conversation will ultimately benefit radiologists and patients alike.

“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,” Strax concluded.

Read the piece in JACR here.

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