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ASSESSMENT OF UTILIZATION OF GONAD SHIELD DURING PELVIC RADIOGRAPHY INGOVERNMENT OWNED HOSPITALS IN ENUGU URBAN

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Abstract

Gonad shield is one of the most important protective measures used during pelvic radiography to protect the gonad which is very sensitive to radiation. This study on assessment of utilization of gonad shield during pelvic radiography in government-owned hospitals in Enugu urban. The study is aimed at investigating if there is inconsistency in the use of gonad shield; determining radiographers level of knowledge on the guidelines for use of gonad shield, ascertaining whether other radiation protecting measures are used often than gonad shield. This research was carried out between May and July 2012 in the UNTH, NOHE, ESUTH. A target population of 52 radiographers practicing in government-owned hospitals in Enugu urban were selected. Also, 100 patients were selected as the target population of the patient. Convenient random sampling method was employed in selecting the sample sizes. Data collected were presented descriptively with aid of tables and charts. The result revealed inconsi

INTRODUCTION

1.0   Background of the Study

Gonad shield is a specially designed contact or shadow shield used to protect the gonad area of a patient from the primary radiation beam during radiographic procedures. The use of gonad shielding has been advocated for patients undergoing pelvic radiography before and during the reproductive years including women less than 40 years of age and all males

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In certain diagnostic X-ray procedures, the patient’s gonads receive radiation doses from primary or scattered radiation. Even though the doses often are small, it is important to keep the gonad doses to patients, at or below the reproductive age, as low as reasonably achievable due to the potential for hereditary damage on offspring.

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 National 

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 and international bodies 

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 recommend the use of gonad shielding when applicable. The effectiveness of gonad shielding is dependent on the correct use of the shield 

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. Furthermore, the use of a shield must not result in significant loss of diagnostic information. The primary duty of radiographers is to produce images of high diagnostic quality with the minimal amount of dose being given to each patient. This duty of care is primarily upheld by using the ‘As low as reasonably achievable’ (ALARA) principle, which incorporates the use of time, distance and shielding in order to minimise patient dose.Along with this, there is a public perception of the hazards of radiation, fed largely by incidents such as Chernobyl and nuclear fallout. Many patients present with an inflated sense of risk asso­ciated with X-ray and expect a radiographer to protect them from this perceived danger.

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This expected protection is almost always in terms of gonad lead shielding. The use of gonad shielding is recommended, with respect to gender, as appropriate, in plain film radiography of the abdomen, pelvis, and lower spine or proximal femoral, and is intended to shield the gonads from the primary radiation beam when it does not interfere with obtaining the required diagnostic information. This is consistent with the recommendations of ICRP Publication 34

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 which states that: ‘The gonads should be shielded when, of necessity, they are directly in the X-ray beam or within 5 cm of it, unless such shielding excludes or degrades important diagnostic information.’ The use of gonad shielding when the region being examined lies further than 5 cm from the gonads, for example the lower leg, serves no useful purpose in terms of radiation dose minimisation. The specific area gonad shielding covers is an area slightly larger than the region of the gonad. It may therefore be used without interfering with the objectives of the examination to protect the germinal tissue of patients from radiation exposures that may cause genetic mutations during many X-ray procedures in which the gonads lie within or are in close proximity to the X-ray field. Therefore, gonad shield should be provided when the following conditions exist: when the gonad lie within the primary X-ray field, or within close proximity (about 5 centimeters) despite proper beam limitation. Examinations during which this is likely to occur include those involving the pelvis, hip, and upper femur, abdominal, lumbar, and lumbosacral spine examinations, intravenous pyelograms, abdominal scout films for barium enemas and upper gastrointestinal (GI) series, and femoral angiograms. As a basis for judgment, the specific area gonad shield should provide attenuation of X-rays at least equivalent to that afforded by 0.25 millimeter of lead. The clinical objectives of the examination will not be compromised, although specific area gonad shield usually does not  obscure needed information except in a few cases such as oblique views of the hip, retrograde urethrograms and voiding cystourethrograms, visualization of the rectum and, occasionally, the pubic symphysis. The decision concerning the applicability of shielding for an individual patient is dependent upon consideration of the patient’s unique anthropometric characteristics and the diagnostic information needs of the examination. The implementation of this policy is the responsibility of the radiographers, thus, gonad shield shall be considered when  the patient has reasonable reproductive potential, when the gonads lie within or close to the direct X-ray beam. The radiographic field shall be restricted to the area of clinical interest by the use of proper collimation. Gonad shielding should be used only when the clinical objectives of the examination will not be compromised. Thus, gonad shielding can be used in the majority of radiographic examination without obscuring visualization of adjacent structures.

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The entrance surface dose for single exposurevaries from 0.26 mGy to 2.89 mGy

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 for pelvic examination depending upon the body size of the patient. The total amount of radiation absorbed increases markedly when multiple X-rays are done, it also rises sharply when computer tomography (CT) scans

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 and fluoroscopic studies are undertaken in thesepatients, whether of the pelvis or other regions of the body.

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 Accordingly, it has been proposed that gonad protection should be carried out during all radiographic examinations whenever possible.

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The aim of this study is to assess the guidelines regarding the use of gonad shield in reducing gonad dose for common diagnostic procedures.

1.1   Statement of the Problem

1. There seems to be inconsistency in the use of gonad shield for patients  undergoing pelvic radiography in which the patient’s gonad may be exposed to direct or scattered radiation.

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2. Radiographers do not show if they have proper knowledge of the guidelines on the use of gonad shield during pelvic radiography as recommended by International Commission on Radiological Protection (ICRP).
3. Observations from clinical postings showed that radiographers often use other radiation protection measures instead of use of gonad shield during pelvic radiography.

1.2  Objectives of the Study

1. To investigate if there is inconsistency in the use of gonad shield during pelvic radiography.
2. To determine level of knowledge of radiographers on use of gonad shield according to its guideline during pelvic radiography.
3. To ascertain whether radiographers employ other radiation protection measures more often to protect the gonad than use of gonad shield during pelvic radiography.
4. To obtain facts and information in these hospitals to be studied that will enable radiation protection officers to ensure proper utilization of gonad shield in order to protect the gonad which is very sensitive to radiation from unnecessary irradiation during pelvic radiography.

   1.3  Significance of the Study

1. This study may be of immense help in reviewing the need for proper utilization of gonad shielding during pelvic radiography.
2. It will help to reduce the amount of radiation patient receive during pelvic radiography.
3. It may be of help to make radiographers to be more aware of use of gonad shielding as important part of radiation protection during pelvic radiography.

1.4   Scope of the Study

This is a cross-sectional study that covered  practicing radiographers and the patient that undergone pelvic radiography during the period of the study in government owned hospitals in Enugu urban. They are University of Nigeria Teaching Hospital (UNTH), National Orthopaedic Hospital Enugu (NOHE), EnuguState University Teaching Hospital (ESUTH).

• Operational Definition of Terms

• Gonad is the male or female reproductive organ that produces the gametes.
• Gonad shield is a specially designed contact or shadow shield used to protect the gonad area of a patient from the primary radiation beam during radiographic procedures. It is generally used for patients who are potentially reproductive, including women less than 40 years of age and all males.
• Pelvic radiography is the examination of pelvic region using X-ray in order to produce an image for diagnosis.
• Pyelogramis an X-ray examination of the pelvis of the kidney using radiopaque contrast medium.
• Urethrography is a technique for X-ray examination of the urethra in which contrast medium is introduced into the urethra so that its outline and any narrowing or other abnormalities may be observed in the X-ray images.
• Pelvis radiography is a radiographic examination used to obtain radiograph of the bones surrounding the hip area. It is used to detect fractures, tumours, or degenerative conditions of bones in the hips, pelvis, and upper legs.